Title of Invention

COMBINATION MOTIF IMMUNE STIMULATORY OLIGONUCLEOTIDES WITH IMPROVED ACTIVITY

Abstract A class of highly immunostimulatory nucleic acids (ODNs) having two distinct motifs, a CpG motif and either a GC-rich motif or a B-cell neutralising motif, is provided. The invention relates in part to ODNs having the formula 5'PX1DCGHX23' or 5'X1DCGHX2P3', wherein X1 and X2 are independently any sequence 0 to 10 bases long, D is any base but C, C is cytosine, G is guanine, H is any base but G, and P is a GC-rich palindrome-containing sequence. This invention also relates in part to ODNs having the formula 5' NX1 DCGHX23' or 5'X1DCGHX2N3', wherein N is a B-cell neutralising sequence. Also provided are ODNs having the formula 5'NPyGN2P3' or 5'N1PyG/IN2P3', wherein N1 is any sequence 1 to 6 bases long, Py is pyrimidine, N2 is any sequence 0 to 30 bases long and G/I is either G or I. Methods of usingthe ODNs of the invention are provided.
Full Text COMBINATION MOTIF IMMUNE STIMULATORY OLIGONUCLEOTIDES WITH
IMPROVED ACTIVITY
Field of the Invention
The present invention relates generally to immunostimulatory nucleic acids,
compositions thereof, and methods of using the immunostimulatory nucleic acids.
Background
Two main classes of immune stimulatory sequences are known in the art which have
differing profiles of immune stimulatory activity. Krieg AM (2001) Trends Microbiol 9:249-
52. These are so-called class B CpG oligodeoxynucleotides (ODN), which are strong
activators of B cells, and class A CpG ODN, which are strong activators of natural killer
(NK) cells. In addition to these immune stimulatory sequences, at least two classes of
neutralizing sequences are known, including CpG sequences in which the CG is preceded by
a C or followed by a G (Krieg AM et al. (1998) Proc Natl AcadSci USA 95:12631-12636),
and DNA sequences in which the CG is methylated. A neutralizing motif is a motif which
has some degree of immunostimulatory capability when present in an otherwise non-
stimulatory motif, but, which when present in the context of other immunostimulatory motifs
serves to reduce the immunostimulatory potential of the other motifs.
Summary of the Invention
A new class of immune stimulatory nucleic acids is provided herein. In some
instances these nucleic acids have a CG-rich palindrome or CG-rich neutralizing motif.
Applicants previously recognized and described oligodeoxynucleotides (ODN) containing
neutralizing motifs consisting of repeats of the sequence CG such as CGCGCG or a CG
dinucleotide preceded by a C (i.e., CCG) and/or followed by a G (i.e., CGG, CCGG). These
neutralizing motifs were believed cause some reduction in stimulatory effects of CpG
containing ODN on multiple readouts, such as secretion of IL-6, IL-12, IFN-?, TNF-a, and
induction of an antigen-specific immune response. Krieg AM et al. (1998) Proc Natl Acad
Sci USA 95:12631-6.
The present invention is based in part on the surprising discovery by the Applicants
that certain ODN containing a combination of a stimulating motif and a neutralizing motif are
highly immunostimulatory. The present invention is also based in part on the surprising
discovery by the Applicants that ODN having certain CG-rich palindromic sequences,
including palindromic sequences containing neutralizing motifs, are highly

immunostimulatory. The neutralizing motif thus, may, but need not occur within the context
of a palindromic sequence to be highly immunostimulatory.
Furthermore, the immunostimulatory ODN of the instant invention have
immunostimulatory effects previously associated with both of two distinct classes of CpG
ODN, those that characteristically activate B cells (class B CpG ODN) and those that
characteristically activate NK cells and induce production of interferon (IFN)-a (class A CpG
ODN). The novel immunostimulatory ODN of the instant invention thus have a spectrum of
immunostimulatory effects distinct from either class A CpG ODN or class B CpG ODN. The
new class of immunostimulatory ODN of the instant invention is referred to as type C CpG
ODN. As described in greater detail below, in certain embodiments the ODN of the present
invention involve a combination of motifs wherein one motif is a CG-rich palindrome or a
neutralizing motif, and another motif is a stimulatory motif, e.g., a CpG motif or the sequence
TCGTCG.
In some aspects an immunostimulatory nucleic acid of 14-100 nucleotides in length is
provided. The nucleic acid has the formula: 5' X1DCGHX2 3'. X1 and X2 are independently
any sequence 0 to 10 nucleotides long. D is a nucleotide other than C. C is cytosine. G is
guanine. H is a nucleotide other than G. The nucleic acid sequence also includes a nucleic
acid sequence selected from the group consisting of P and N positioned immediately 5' to X1
or immediately 3' to X2. N is a B-cell neutralizing sequence which begins with a CGG
trinucleotide and is at least 10 nucleotides long. P is a GC-rich palindrome containing
sequence at least 10 nucleotides long.
In some embodiments the immunostimulatory nucleic acid is 5' NX1DCGHX2 3', 5'
X1DCGHX2N 3' 5' PX1DCGHX2 3' 5' X1DCGHX2P 3', 5' X1DCGHX2PX3 3', 5'
X,DCGHPX3 3', 5' DCGHX2PX3 3' 5' TCGHX2PX3 3', or 5' DCGHPX3 3'. X3 is any
sequence 0 to 10 nucleotides long. In other embodiments the immunostimulatory nucleic
acid is 5' DCGHP 3'.
Optionally D and/or H are thymine (T).
In other embodiments H is T and X2 is CG, CGT, CGTT, CGTTT, or CGTTTT.
H is T and X2 is CG or CGTTTT according to other embodiments.
According to other embodiments C is unmethylated.
N includes at least four CG dinucleotides and no more than two CCG trinucleotides in
some embodiments.

Optionally P includes at least one Inosine.
The nucleic acid may also include a poly-T sequence at the 5' end or the 3' end.
An immunostimulatory nucleic acid of 13-100 nucleotides in length is provided
according to other aspects of the invention. The nucleic acid has the formula: 5' NtPyGN2P
3'. G is guanine.
N1 is any sequence 1 to 6 nucleotides long. In some embodiments N1 is at least 50%
pyrimidines and preferably at least 50% T. In other embodiments N1 includes at least one CG
motif, at least one TCG motif, at least one CI motif, at least one TCI motif, at least one IG
motif, or at least one TIG motif. N1 is TCGG or TCGH in other embodiments. H is a
nucleotide other than G.
Py is a pyrimidine. In some embodiments Py is an unmethylated C.
N2 is any sequence 0 to 30 nucleotides long. In some embodiments N2 is at least 50%
pyrimidines or is at least 50% T. In other embodiments N2 does not includes any poly G or
poly A motifs.
P is a GC-rich palindrome containing sequence at least 10 nucleotides long. In some
embodiments P is completely palindromic. In other embodiments P is a palindrome having
between 1 and 3 consecutive intervening nucleotides. Optionally the intervening nucleotides
may be TG. In other embodiments P includes at least 3,4, or 5 C and at least 3,4, or 5 G
nucleotides. According to other embodiments P includes at least one Inosine.
In one embodiment the GC-rich palindrome has a base content of at least two-thirds G
and C. In another embodiment the GC-rich palindrome has a base content of at least 81
percent G and C. In some embodiments the GC-rich palindrome is at least 12 nucleotides
long. The GC-rich palindrome may be made up exclusively of C and G. In some
embodiments the GC-rich palindrome can include at least one nucleotide that is neither C nor
G.
In some embodiments the GC-rich palindrome includes at least one CGG trimer, at
least one CCG trimer, or at least one CGCG tetramer. In some embodiments the GC-rich
palindrome includes at least four CG dinucleotides. In certain preferred embodiments the
GC-rich palindrome has a central CG dinucleotide.
In certain embodiments the GC-rich palindrome is CGGCGCGCGCCG (SEQ ID NO:
23), CGGCGGCCGCCG (SEQ ID NO: 28), CGACGATCGTCG (SEQ ID NO: 68) or
CGACGTACGTCG (SEQ ID NO: 69).

In certain embodiments the GC-rich palindrome is not CGCGCGCGCGCG (SEQ ID
NO: 29), GCGCGCGCGCGC (SEQ ID NO: 30), CCCCCCGGGGGG (SEQ ID NO: 31),
GGGGGGCCCCCC (SEQ ID NO: 32), CCCCCGGGGG (SEQ ID NO: 33) or
GGGGGCCCCC (SEQ ID NO: 34).
In some embodiments N1PyGN2 is a sequence selected from the group consisting of
TTTTTCG, TCG, TTCG, TTTCG, TTTTCG, TCGT, TTCGT, TTTCGT, and TCGTCGT.
An immunostimulatory nucleic acid of 13-100 nucleotides in length is provided
according to other aspects of the invention. The nucleic acid has the formula: 5' N1PyG/IN2P
3'. G/I refers to single nucleotide which is either a G or an I. G is guanine and I is Inosine.
N1 is any sequence 1 to 6 nucleotides long. Py is a pyrimidine. N2 is any sequence 0
to 30 nucleotides long.
P is a palindrome containing sequence at least 10 nucleotides long. In some
embodiments P is a GC-rich palindrome. In other embodiments P is an IC-rich palindrome.
N1PyIN2 in some embodiments is TCITCITTTT (SEQ ID NO: 47).
The nucleic acid molecules described herein may have any type of backbone
composition. In some embodiments the immunostimulatory nucleic acid has a completely
nuclease-resistant backbone. The nuclease-resistant backbone may be composed of
phosphorothioate linkages. In other embodiments the immunostimulatory nucleic acid has a
completely phosphodiester backbone. In yet other embodiments the immunostimulatory
nucleic acid has a chimeric backbone. In one embodiment the immunostimulatory nucleic
acid has at least one phosphodiester linkage between a CG, CI or a IG motif. Alternatively,
the ODN of the instant invention are formulated with microparticles, emulsions, or other
means to avoid rapid digestion in vivo.
The immunostimulatory nucleic acid molecules described herein have a variety of
lengths. In some embodiments the immunostimulatory nucleic acid is 13-100, 13-40, 13-30,
14-100, 14-40, or 14-30 nucleotides in length or any integer therebetween.
An immunostimulatory nucleic acid having one of the following sequences is also
provided: TCGTCGTTTTCGGCGCGCGCCG (SEQ ID NO: 1),
TCGTCGTTTTCGGCGGCCGCCG (SEQ ID NO: 4), TCGTCGTTTTCGGCGCGCCGCG
(SEQ ID NO: 5), TCGTCGTTTTCGGCGCCGGCCG (SEQ ID NO: 6),
TCGTCGTTTTCGGCCCGCGCGG (SEQ ID NO: 7),
TCGTCGTTTTCGGCGCGCGCCGTTTTT (SEQ ID NO: 12),

TCCTGACGTTCGGCGCGCGCCG (SEQ ID NO: 13), TZGTZGTTTTZGGZGZGZGZZG
(SEQ ID NO: 14), wherein Z is 5-methylcytosine, TCCTGACGTTCGGCGCGCGCCC
(SEQ ID NO: 19), TCGGCGCGCGCCGTCGTCGTTT (SEQ ID NO: 11),
TCCTGACGTTCGGCGCGCGCCC (ODN 2136, SEQ ID NO: 19),
TCGTCGTTTTCGGCGGCCGACG (ODN 5513, SEQ ID NO: 64),
TCGTCGTTTTCGTCGGCCGCCG (ODN 5514, SEQ ID NO: 65),
TCGTCGTTTTCGACGGCCGCCG (ODN 5515, SEQ ID NO: 66), and
TCGTCGTTTTCGGCGGCCGTCG (ODN 5516, SEQ ID NO: 67).
Further according to other embodiments of the invention the immunostimulatory
nucleic acid is one of the following sequences: TCGTCGTTTTCGGCGCGCGCCG (ODN
2395), TCGTCGTTTTCGGCGGCCGCCG (ODN 2429),
TCGTCGTTTTCGGCGCGCCGCG (ODN 2430), TCGTCGTTTTCGGCGCCGGCCG
(ODN 2431), TCGTCGTTTTCGGCCCGCGCGG (ODN 2432),
TCGTCGTTTTCGGCGCGCGCCGTTTTT (ODN 2452),
TCCTGACGTTCGGCGCGCGCCG (ODN 5315), TZGTZGTTTTZGGZGZGZGZZG
(ODN 5327, wherein Z is 5-methylcytosine), TCCTGACGTTCGGCGCGCGCCC (ODN
2136), TCGTCGTTTTCGGCGGCCGACG (ODN 5513),
TCGTCGTTTTCGTCGGCCGCCG (ODN 5514), TCGTCGTTTTCGACGGCCGCCG
(ODN 5515), TCGTCGTTTTCGGCGGCCGTCG (ODN 5516),
TCGTCGTTTTCGGCGCGCGCCG (ODN 2395), TCGTCGTTTTCGGCGGCCGCCG
(ODN 2429), TCGTCGTTTTCGGCGCGCCGCG (ODN 2430),
TCGTCGTTTTCGGCGCCGGCCG (ODN 2431), TCGTCGTTTTCGGCCCGCGCGG
(ODN 2432), TCGTCGTTTTCGGCGCGCGCCGTTTTT (ODN 2452),
TCCTGACGTTCGGCGCGCGCCG (ODN 5315), TZGTZGTTTTZGGZGZGZGZZG
(ODN 5327, wherein Z is 5-methylcytosine), TCCTGACGTTCGGCGCGCGCCC (ODN
2136), TCGTCGTTTTCGGCGGCCGACG (ODN 5513),
TCGTCGTTTTCGTCGGCCGCCG (ODN 5514), TCGTCGTTTTCGACGGCCGCCG
(ODN 5515), TCGTCGTTTTCGGCGGCCGTCG (ODN 5516),
TCGGCGCGCGCCGTCGTCGTTT (ODN 2451), TCGTCGTTTCGACGGCCGTCG (ODN
20173, SEQ ID NO: 71), TCGTCGTTTCGACGATCGTCG (ODN 20176, SEQ ID NO: 72),
TCGTCGTTTCGACGTACGTCG (ODN 20177, SEQ ID NO: 73),
TCGTCGCGACGGCCGTCG (ODN 20178, SEQ ID NO: 74),

TCGTCGCGACGATCGTCG (ODN 20179, SEQ ID NO: 75),
TCGTCGCGACGTACGTCG (ODN 20180, SEQ ID NO: 76),
TCGTTTTTTTCGACGGCCGTCG (ODN 20184, SEQ ID NO: 77),
TCGTTTTTTTCGACGATCGTCG (ODN 20185, SEQ ID NO: 78), and
TCGTTTTTTTCGACGTACGTCG (ODN 20186, SEQ ID NO: 79).
According to certain embodiments the immunostimulatory nucleic acid includes the
sequence TCGGCGCGCGCCGTCGTCGTTT (ODN 2451, SEQ ID NO: 11). In certain
embodiments the immunostimulatory nucleic acid is the sequence
TCGGCGCGCGCCGTCGTCGTTT (ODN 2451).
A pharmaceutical composition, comprising the immunostimulatory nucleic acids
described herein and a pharmaceutically acceptable carrier is provided according to other
aspects of the invention.
In other aspects of the invention a method for inducing type 1 interferon (IFN)
expression is provided. The method involves contacting a cell capable of expressing type 1
IFN with an effective amount of an immunostimulatory nucleic acid described herein to
induce expression of type 1 IFN.
The invention in other aspects is a method for activating a natural killer (NK) cell.
The method involves contacting an NK cell with an effective amount of an
immunostimulatory nucleic acid described herein to activate the NK cell.
In yet other aspects the invention is a method for treating infection by administering
to a subject having or at risk of developing an infection an effective amount of an
immunostimulatory nucleic acid described herein, to treat or prevent the infection. In some
embodiments the subject has or is at risk of developing an infection selected from the group
consisting of a viral, bacterial, fungal and parasitic infection.
In certain embodiments the method involves administering an immunostimulatory
nucleic acid of the invention alone to treat or prevent the infection. In certain embodiments
the method according to this aspect of the invention further includes administering to the
subject an antibiotic agent, which may be an antibacterial agent, an antiviral agent, an
antifungal agent, or an antiparasitic agent.
In other aspects the invention is a method for treating an allergic condition by
administering to a subject having or at risk of developing an allergic condition an effective

amount of an immunostimulatory nucleic acid described herein, to treat or prevent the
allergic condition. In some embodiments the allergic condition is allergic asthma.
In one embodiment the allergic condition is asthma. In certain embodiments the method
involves administering an immunostimulatory nucleic acid of the invention alone to treat or
prevent the allergic condition. In certain embodiments the method according to this aspect of
the invention further includes administering to the subject an asthma/allergy medicament e.g.,
steroids, antihistamines, and prostaglandin inducers.
A method for treating cancer is provided according to other aspects of the invention.
The method involves administering to a subject having or at risk of developing a cancer an
effective amount of an immunostimulatory nucleic acid described herein, to treat or prevent
the cancer. In some embodiments the cancer is selected from the group consisting of basal
cell carcinoma, biliary tract cancer; bladder cancer; bone cancer; brain and CNS cancer;
breast cancer; cervical cancer; choriocarcinoma; colon and rectum cancer; connective tissue
cancer; cancer of the digestive system; endometrial cancer; esophageal cancer; eye cancer;
cancer of the head and neck; gastric cancer; intra-epithelial neoplasm; kidney cancer; larynx
cancer; leukemia; liver cancer; lung cancer (e.g. small cell and non-small cell); lymphoma
including Hodgkin's and Non-Hodgkin's lymphoma; melanoma; myeloma; neuroblastoma;
oral cavity cancer (e.g., lip, tongue, mouth, and pharynx); ovarian cancer; pancreatic cancer;
prostate cancer; retinoblastoma; rhabdomyosarcoma; rectal cancer; renal cancer; cancer of the
respiratory system; sarcoma; skin cancer; stomach cancer; testicular cancer; thyroid cancer;
uterine cancer; cancer of the urinary system, and other carcinomas and sarcomas
In certain embodiments the method involves administering an immunostimulatory
nucleic acid of the invention alone to treat the cancer. In certain embodiments the method
according to this aspect of the invention further includes administering to the subject an anti-
cancer medicament or treatment e.g., chemotherapeutic agents, radiation.
Each of the limitations of the invention can encompass various embodiments of the
invention. It is, therefore, anticipated that each of the limitations of the invention involving
any one element or combinations of elements can be included in each aspect of the invention.
Brief Description of the Drawings
The following figures are provided for illustrative purposes only and are not required
for understanding or practicing the invention.

Figure 1 is a bar graph depicting amounts of IFN-a (pg/ml) induced in human
PBMCs after 24 hours of culture alone, with IL-2, or in the presence of the indicated ODN at
the indicated concentrations.
Figure 2 is a bar graph depicting amounts of MCP-1 (pg/ml) induced in human
PBMCs after 24 hours of culture alone, with IL-2, or in the presence of the indicated ODN at
the indicated concentrations.
Figure 3 is a bar graph depicting amounts of IP-10 (pg/ml) induced in human PBMCs
after 24 hours of culture alone, with IL-2, or in the presence of the indicated ODN at the
indicated concentrations.
Figure 4 is a bar graph depicting amounts of IFN-a (pg/ml) induced in human
PBMCs after 48 hours of culture alone (N/A) or in the presence of the indicated ODN at 1.0
µg/ml.
Figure 5 is a pair of bar graphs depicting surface staining on B cells for CD86 (MFI)
after 48 hours of culture alone (N/A) or in the presence of the indicated ODN at 0.25 µg/ml
(panel A) or 1.0 µg/ml (panel B).
Figure 6 is a pair of bar graphs depicting results of a 72 hour B cell proliferation assay
(cpm 3H-thymidine incorporation) alone (N/A) or in the presence of the indicated ODN at
0.25 µg/ml (panel A) or 1.0 µg/ml (panel B).
Figure 7 is a pair of bar graphs depicting amounts of IL-10 (pg/ml) induced in human
PBMCs after 24 hours of culture either alone (N/A) or in the presence of the indicated ODN
at 0.25 µg/ml (panel A) or 1.0 µg/ml (panel B).
Figure 8 is a bar graph depicting amounts of IFN-a (pg/ml) induced in PBMC from
two donors (D127, solid bars, and D124, open bars) following 24 hours of culture alone (w/o)
or in the presence of the indicated ODN at the indicated concentrations (1 or 6 µg/ml).
Figure 9 is a bar graph depicting B cell activation as measured by percent CD86-
positive cells in human PBMC cultured for 24 hours alone (w/o) or in the presence of the
indicated ODN at the indicated concentrations (0.4,1.0, or 10.0 µg/ml).
Figure 10 is a bar graph depicting the amount of IFN-a (pg/ml) secreted by PBMC
from two donors (D141, open bars, and D142, solid bars) following 24 hours of culture alone
(w/o) or in the presence of the indicated ODN at the indicated concentrations (I or 6 µg/ml).

Figure 11 is a bar graph depicting the amount of IFN-a (pg/ml) secreted by PBMC
from two donors (D141, open bars, and D142, solid bars) following 48 hours of culture alone
(w/o) or in the presence of the indicated ODN at the indicated concentrations (1 or 6 µg/ml).
Figure 12 is a bar graph depicting the amount of IFN-a (pg/ml) secreted by PBMC
from two donors (D141, shaded bars, and D142, open bars) following 24 hours of culture
alone (w/o) or in the presence of the indicated ODN at 6 µg/ml.
Figure 13 is a series of three bar graphs depicting the amount of IFN-y (pg/ml)
secreted by PBMC following 24 hours of culture alone (n/a) or in the presence of the
indicated ODN at the indicated concentrations (1, 3 or 10 µg/ml in panels A, B, and C,
respectively).
Figure 14 is a bar graph depicting the percentage of CD3+ cells staining positive for
IFN-y following 48 hours of culture alone (NA) or in the presence of the indicated ODN.
Figure 15 is a bar graph depicting the mean fluorescence intensity (MFI) of IFN-?
staining in T cells following 48 hours of culture alone (NA) or in the presence of the
indicated ODN.
Figure 16 is a bar graph depicting the amount of IFN-a (pg/ml) secreted by human
PBMC following 24 hours of culture alone (N/A) or in the presence of the indicated ODN at
1.0 µg/ml.
Figure 17 is a pair of bar graphs depicting the amount of IFN-a (pg/ml) secreted by
human PBMC following 24 or 48 hour culture alone (w/o) or in the presence of the indicated
ODN at the indicated concentration (1 or 6 (µg/ml). Panel A depicts results for PBMC pooled
from two donors. Panel B depicts results for PBMC obtained from two donors (D141 and
D142).
Figure 18 is a bar graph depicting the percent CD86-positive B cells following 24
hours of culture alone (w/o) or in the presence of the indicated ODN at the indicated
concentrations (0.4 and 1.0 µg/ml).
Figure 19 is a series of three bar graphs depicting the concentration of IFN-? (pg/ml)
in culture supernatants of human PBMC after incubation alone (w/o), with LPS, or with the
indicated ODN at the indicated concentrations (0.2 to 1.0 µg/ml) for 6 hours (panel A), 24
hours (panel B), or 48 hours (panel C).

Figure 20 is a bar graph depicting the amount IFN-? (pg/ml) generated in a two-way
mixed lymphocyte reaction (MLR) in which lymphocytes obtained from two donors were
cultured for 24 hours alone (w/o) or in the presence of the indicated ODN at 6 µg/ml and then
mixed.
Figure 21 is a series of three bar graphs depicting the concentration of 1L-10 (pg/ml)
in culture supernatants of human PBMC after incubation alone (w/o), with LPS, or with the
indicated ODN at the indicated concentrations (0.2 to 1.0 µg/ml) for 6 hours (panel A), 24
hours (panel B), or 48 hours (panel C).
Figure 22 is a bar graph depicting the amounts of IP-10 (pg/ml) in PBMC
supernatants after 24 hours of incubation alone (n/a) or in the presence of controls (IL-2,
ODN 1585 (GGGGTCAACGTTGAGGGGGG, SEQ ID NO: 35) and ODN 2118
(GGGGTCAAGCTTGAGGGGGG, SEQ ID NO: 36)) or various indicated ODN at either 0.6
µg/ml (open bars) or 3.0 µg/ml (solid bars).
Figure 23 is a pair of bar graphs depicting the amounts of IFN-a (pg/ml) in PBMC
supernatants after 24 hours of incubation alone (n/a) or in the presence of controls (IL-2,
ODN 1585, and ODN 2118) or various indicated ODN at either 0.6 µg/ml (panel A) or 3.0
µg/ml (panel B).
Figure 24 is a bar graph depicting the amounts of IFN-y (pg/ml) in PBMC
supernatants after 24 hours of incubation alone (n/a) or in the presence of controls (IL-2.
ODN 1585, and ODN 2118) or various indicated ODN at either 0.6 µg/ml (open bars) or 3.0
µg/ml (filled bars).
Figure 25 is a bar graph depicting the amounts of IL-6 (pg/ml) in PBMC supernatants
after 24 hours of incubation alone (n/a) or in the presence of controls (IL-2, ODN 1585, and
ODN 2118) or various indicated ODN at either 0.6 fig/ml (open bars) or 3.0 µg/ml (filled
bars).
Figure 26 is a bar graph depicting amounts of IFN-a secretion (pg/ml) by PBMC
following 24 hours of culture alone (w/o) or in the presence of the indicated ODN at the
indicated concentrations (3.0 and 6.0 µg/ml).
Detailed Description of the Invention
It has been discovered that certain oligodeoxynucleotides (ODN), which contain at
least two distinct motifs have unique and desirable stimulatory effects on cells of the immune
system. Some of these ODN have both a traditional "stimulatory" CpG sequence and a

"GC-rich" or "B-cell neutralizing" motif. These combination motif nucleic acids have
immune stimulating effects that fall somewhere between those effects associated with
traditional "class B" CpG ODN, which are strong inducers of B cell activation and dendritic
cell (DC) activation, and those effects associated with a more recently described class of
immune stimulatory nucleic acids ("class A" CpG ODN) which are strong inducers of IFN-a
and natural killer (NK) cell activation but relatively poor inducers of B-cell and DC
activation. Krieg AM et al. (1995) Nature 374:546-9; Ballas ZK et al. (1996) J Immunol
157:1840-5; Yamamoto S et al. (1992) J Immunol 148:4072-6. While preferred class B CpG
ODN often have phosphorothioate backbones and preferred class A CpG ODN have mixed or
chimeric backbones, the new class of combination motif immune stimulatory nucleic acids
may have either stabilized, e.g., phosphorothioate, chimeric, or phosphodiester backbones.
In one aspect the invention provides immune stimulatory nucleic acids belonging to
this new class of combination motif immune-stimulatory nucleic acids. The B cell
stimulatory domain is defined by a formula: 5' X1DCGHX2 3'. D is a nucleotide other than C.
C is cytosine. G is guanine. H is a nucleotide other than G.
X1 and X2 are any nucleic acid sequence 0 to 10 nuclcotides long. X1 may include a
CG, in which case there is preferably a T immediately preceding this CG. In some
embodiments DCG is TCG. X1 is preferably from 0 to 6 nucleotides in length. In some
embodiments X2 does not contain any poly G or poly A motifs. In other embodiments the
immunostimulatory nucleic acid has a poly-T sequence at the 5' end or at the 3' end. As used
herein, "poly-A" or "poly-T" shall refer to a stretch of four or more consecutive A's or T's
respectively, e.g., 5' AAAA 3' or 5' TTTT 3'.
As used herein, "poly-G end" shall refer to a stretch of four or more consecutive G's,
e.g., 5' GGGG 3', occurring at the 5' end or the 3' end of a nucleic acid. As used herein,
"poly-G nucleic acid" shall refer to a nucleic acid having the formula 5' X1X2GGGX3X4 3'
wherein X1, X2, X3, and X4 are nucleotides and preferably at least one of X3 and X4 is a G.
Some preferred designs for the B cell stimulatory domain under this formula comprise
TTTTTCG, TCG, TTCG, TTTCG, TTTTCG, TCGT, TTCGT, TTTCGT, TCGTCGT.
The second motif of the nucleic acid is referred to as either P or N and is positioned
immediately 5' to X1 or immediately 3' to X2.
N is a B-cell neutralizing sequence that begins with a CGG trinucleotide and is at
least 10 nucleotides long. A B-cell neutralizing motif includes at least one CpG sequence in

which the CG is preceded by a C or followed by a G (Krieg AM et al. (1998) Proc Natl Acad
Sci USA 95:12631-12636) or is a CG containing DNA sequence in which the C of the CG is
methylated. As used herein, "CpG" shall refer to a 5' cytosine (C) followed by a 3' guanine
(G) and linked by a phosphate bond. At least the C of the 5' CG 3' must be unmethylated.
Neutralizing motifs are motifs which has some degree of immunostimulatory capability when
present in an otherwise non-stimulatory motif, but, which when present in the context of
other immunostimulatory motifs serve to reduce the immunostimulatory potential of the other
motifs.
P is a GC-rich palindrome containing sequence at least 10 nucleotides long. As used
herein, "palindrome" and, equivalently, "palindromic sequence" shall refer to an inverted
repeat, i.e., a sequence such as ABCDEE'D'C'B'A' in which A and A', B and B', etc., are
bases capable of forming the usual Watson-Crick base pairs.
As used herein, "GC-rich palindrome" shall refer to a palindrome having a base
composition of at least two-thirds G's and C's. In some embodiments the GC-rich domain is
preferably 3' to the "B cell stimulatory domain". In the case of a 10-base long GC-rich
palindrome, the palindrome thus contains at least 8 G's and C's. In the case of a 12-base long
GC-rich palindrome, the palindrome also contains at least 8 G's and C's. In the case of a 14-
mer GC-rich palindrome, at least ten bases of the palindrome are G's and C's. In some
embodiments the GC-rich palindrome is made up exclusively of G's and C's.
In some embodiments the GC-rich palindrome has a base composition of at least 81
percent G's and C's. In the case of such a 10-base long GC-rich palindrome, the palindrome
thus is made exclusively of G's and C's. In the case of such a 12-base long GC-rich
palindrome, it is preferred that at least ten bases (83 percent) of the palindrome are G's and
C's. In some preferred embodiments, a 12-base long GC-rich palindrome is made
exclusively of G's and C's. In the case of a 14-mer GC-rich palindrome, at least twelve bases
(86 percent) of the palindrome are G's and C's. In some preferred embodiments, a 14-base
long GC-rich palindrome is made exclusively of G's and C's. The C's of a GC-rich
palindrome can be unmethylated or they can be methylated.
In general this domain has at least 3 Cs and Gs, more preferably 4 of each, and most
preferably 5 or more of each. The number of Cs and Gs in this domain need not be identical.
It is preferred that the Cs and Gs are arranged so that they are able to form a self-
complementary duplex, or palindrome, such as CCGCGCGG. This may be interrupted by As

or Ts, but it is preferred that the self-complementarity is at least partially preserved as for
example in the motifs CGACGTTCGTCG (SEQ ID NO: 80) or CGGCGCCGTGCCG (SEQ
ID NO: 81). When complementarity is not preserved, it is preferred that the non-
complementary base pairs be TG. In a preferred embodiment there are no more than 3
consecutive bases that are not part of the palindrome, preferably no more than 2, and most
preferably only 1. In some embodiments the GC-rich palindrome includes at least one CGG
trimer, at least one CCG trimer, or at least one CGCG tetramer. In other embodiments the
GC-rich palindrome is not CCCCCCGGGGGG (SEQ ID NO: 31) or GGGGGGCCCCCC
(SEQ ID NO: 32), CCCCCGGGGG (SEQ ID NO: 33) or GGGGGCCCCC (SEQ ID NO:
34).
At least one of the G's of the GC rich region may be substituted with an inosine (I).
In some embodiments P includes more than one I.
In certain embodiments the immunostimulatory nucleic acid has one of the following
formulas 5' NX1DCGHX2 3', 5' X1DCGHX2N 3', 5' PX,DCGHX2 3', 5' X,DCGHX2P 3', 5'
X,DCGHX2PX3 3', 5' X1DCGHPX3 3', 5' DCGHX2PX3 3', 5' TCGHX2PX3 3', 5' DCGHPXj
3', or 5' DCGHP 3'.
In other aspects the invention provides immune stimulatory nucleic acids which are
defined by a formula: 5' N|PyGN2P 3'. N| is any sequence 1 to 6 nucleotides long. Py is a
pyrimidine. G is guanine. N2 is any sequence 0 to 30 nucleotides long. P is a GC-rich
palindrome containing sequence at least 10 nucleotides long.
N1 and N2 may contain more than 50% pyrimidines, and more preferably more than
50% T. N1 may include a CG, in which case there is preferably a T immediately preceding
this CG. In some embodiments N1PyG is TCG (such as ODN 5376, which has a 5' TCGG),
and most preferably a TCGN2, where N2 is not G.
N1PyGN2P may include one or more inosine (I) nucleotides. Either the C or the G in
Nl may be replaced by inosine, but the Cpl is preferred to the IpG. For inosine substitutions
such as IpG, the optimal activity may be achieved with the use of a "semi-soft" or chimeric
backbone, where the linkage between the IG or the CI is phosphodiester. N| may include at
least one CI, TCI, IG or TIG motif.
In certain embodiments N|PyGN2 is a sequence selected from the group consisting of
TTTTTCG, TCG, TTCG, TTTCG, TTTTCG, TCGT, TTCGT, TTTCGT, and TCGTCGT.

In other aspects the invention provides immune stimulatory nucleic acids which are
defined by a formula: 5' NiPyG/ItyP 3'. Ni is any sequence 1 to 6 nucleotides long. Py is a
pyrimidine, G/I refers to single nucleotide which is either a G or an I. G is guanine and I is
inosine. N2 is any sequence 0 to 30 nucleotides long. P is a GC or IC rich palindrome
containing sequence at least 10 nucleotides long. In some embodiments N1PyIN2 is
TCITCITTTT (SEQ ID NO: 47).
Some non-limiting examples of combination motif immune stimulatory nucleic acids,
which are described by the formulas above, include the following:
TCGTCGTTTTCGGCGCGCGCCG (ODN 2395), TCGTCGTTTTCGGCGGCCGCCG
(ODN 2429), TCGTCGTTTTCGGCGCGCCGCG (ODN 2430),
TCGTCGTTTTCGGCGCCGGCCG (ODN 2431), TCGTCGTTTTCGGCCCGCGCGG
(ODN 2432), TCGTCGTTTTCGGCGCGCGCCGTTTTT (ODN 2452),
TCCTGACGTTCGGCGCGCGCCG (ODN 5315), TZGTZGTTTTZGGZGZGZGZZG
(ODN 5327, wherein Z is 5-methylcytosine), TCCTGACGTTCGGCGCGCGCCC (ODN
2136), TCGTCGTTTTCGGCGGCCGACG (ODN 5513),
TCGTCGTTTTCGTCGGCCGCCG (ODN 5514), TCGTCGTTTTCGACGGCCGCCG
(ODN 5515), TCGTCGTTTTCGGCGGCCGTCG (ODN 5516),
TCGGCGCGCGCCGTCGTCGTTT (ODN 2451), TCGTCGTTTCGACGGCCGTCG (ODN
20173), TCGTCGTTTCGACGATCGTCG (ODN 20176),
TCGTCGTTTCGACGTACGTCG (ODN 20177), TCGTCGCGACGGCCGTCG (ODN
20178), TCGTCGCGACGATCGTCG (ODN 20179), TCGTCGCGACGTACGTCG (ODN
20180), TCGTTTTTTTCGACGGCCGTCG (ODN 20184),
TCGTTTTTTTCGACGATCGTCG (ODN 20185), TCGTTTTTTTCGACGTACGTCG
(ODN 20186), TIGTIGTTTTCGGCGGCCGCCG (ODN 5569, SEQ ID NO: 63), and
TCITCITTTTCGGCGGCCGCCG (ODN 5570, SEQ ID NO: 70).
As used herein, "nucleic acid" and "oligonucleotide" are used interchangeably and
shall refer to mean multiple nucleotides (i.e., molecules comprising a sugar (e.g., ribose or
deoxyribose) linked to a phosphate group and to an exchangeable organic base, which is
either a substituted pyrimidine (e.g., cytosine (C), thymine (T) or uracil (U)) or a substituted
purine (e.g., adenine (A) or guanine (G)). As used herein, the terms refer to
oligoribonucleotides as well as oligodeoxyribonucleotides (ODN). The terms shall also
include polynucleosides (i.e., a polynucleotide minus the phosphate) and any other organic

base containing polymer. Nucleic acid molecules can be obtained from existing nucleic acid
sources (e.g., genomic or cDNA), but are preferably synthetic (e.g., produced by nucleic acid
synthesis).
The terms nucleic acid and oligonucleotide also encompass nucleic acids or
oligonucleotides with substitutions or modifications, such as in the bases and/or sugars. For
example, they include nucleic acids having backbone sugars which are covalently attached to
low molecular weight organic groups other than a hydroxyl group at the 31 position and other
than a phosphate group at the 5' position. Thus modified nucleic acids may include a 2'-O-
alkylated ribose group. In addition, modified nucleic acids may include sugars such as
arabinose instead of ribose. Thus the nucleic acids may be heterogeneous in backbone
composition thereby containing any possible combination of polymer units linked together
such as peptide- nucleic acids (which have amino acid backbone with nucleic acid bases). In
some embodiments, the nucleic acids are homogeneous in backbone composition. Nucleic
acids also include substituted purines and pyrimidines such as C-5 propyne modified bases.
Wagner RW et al. (1996) Nat Biotechnol 14:840-4. Purines and pyrimidines include but are
not limited to adenine, cytosine, guanine, thymidine, 5-methylcytosine, 2-aminopurine,
2-amino-6-chloropurine, 2,6-diaminopurine, hypoxanthine, and other naturally and
non-naturally occurring nucleobases, substituted and unsubstituted aromatic moieties. Other
such modifications are well known to those of skill in the art.
The immunostimulatory oligonucleotides of the instant invention can encompass
various chemical modifications and substitutions, in comparison to natural RNA and DNA,
involving a phosphodiester internucleoside bridge, a p-D-ribose unit and/or a natural
nucleoside base (adenine, guanine, cytosine, thymine, uracil). Examples of chemical
modifications are known to the skilled person and are described, for example, in Uhlmann E
et al. (1990) Chem Rev 90:543; "Protocols for Oligonucleotides and Analogs" Synthesis and
Properties & Synthesis and Analytical Techniques, S. Agrawal, Ed, Humana Press, Totowa,
USA 1993; Crooke ST et al. (1996) Annu Rev Pharmacol Toxicol 36:107-129; and Hunziker
J et al. (1995) Mod Synth Methods 7:331-417. An oligonucleotide according to the invention
can have one or more modifications, wherein each modification is located at the a particular
phosphodiester internucleoside bridge and/or at a particular p-D-ribose unit and/or at a
particular natural nucleoside base position in comparison to an oligonucleotide of the same
sequence which is composed of natural DNA or RNA.

For example, the invention relates to an oligonucleotide which may comprise one or
more modifications and wherein each modification is independently selected from:
a) the replacement of a sugar phosphate unit from the sugar phosphate backbone by
another unit,
b) the replacement of a p-D-ribose unit by a modified sugar unit, and
c) the replacement of a natural nucleoside base by a modified nucleoside base.
More detailed examples for the chemical modification of an oligonucleotide are as
follows.
A sugar phosphate unit (i.e., a P-D-ribose and phosphodiester internucleoside bridge
together forming a sugar phosphate unit) from the sugar phosphate backbone (i.e., a sugar
phosphate backbone is composed of sugar phosphate units) can be replaced by another unit,
wherein the other unit is for example suitable to build up a "morpholino-derivative" oligomer
(as described, for example, in Stirchak EP et al. (1989) Nucleic Acids Res 17:6129-41), that
is, e.g., the replacement by a morpholino-derivative unit; or to build up a polyamide nucleic
acid ("PNA"; as described for example, in Nielsen PE et al. (1994) Bioconjug Chem 5:3-7),
that is, e.g., the replacement by a PNA backbone unit, e.g., by 2-aminoethylglycine.
A p-ribose unit or a p-D-2'-deoxyribose unit can be replaced by a modified sugar unit,
wherein the modified sugar unit is for example selected from ß-D-ribose, a-D-2'-
deoxyribose, L-2'-deoxyribose, 2'-F-2'-deoxyribose, 2'-O-(C1-C6)alkyl-ribose, preferably 2'-
O-(C1-C6)alkyl-ribose is 2'-O-methylribose, 2'-O-(C2-C6)alkenyl-ribose, 2'-[O-(C1-C6)alkyl-
O-(C1-C6)alkyl]-ribose, 2'-NH2-2'-deoxyribose, ß-D-xylo-furanose, a-arabinofuranose,
2,4-dideoxy-ß-D-erythro-hexo-pyranose, and carbocyclic (described, for example, in Froehler
J (1992) Am Chem Soc 114:8320) and/or open-chain sugar analogs (described, for example,
in Vandendriessche et al. (1993) Tetrahedron 49:7223) and/or bicyclosugar analogs
(described, for example, in Tarkov M et al. (1993) Helv Chim Acta 76:481).
A natural nucleoside base can be replaced by a modified nucleoside base, wherein the
modified nucleoside base is for example selected from hypoxanthine, uracil, dihydrouracil,
pseudouracil, 2-thiouracil, 4-thiouracil, 5-aminouracil, 5-(C1-C6)-alkyluracil, 5-(C2-C6)-
alkenyluracil, 5-(C2-C6)-alkynyluracil, 5-(hydroxymethyl)uracil, 5-chlorouracil,
5-fluorouracil, 5-bromouracil, 5-hydroxycytosine, 5-(C1-C6)-alkylcytosine, 5-(C2-C6)-
alkenylcytosine, 5-(C2-C6)-alkynylcytosine, 5-chlorocytosine, 5-fluorocytosine,
5-bromocytosine, N2-dimethylguanosine, 2,4-diamino-purine, 8-azapurine, a substituted

7-deazapurine, preferably 7-dcaza-7-substituted and/or 7-deaza-8-substituted purine or other
modifications of a natural nucleoside bases. This list is meant to be exemplary and is not to
be interpreted to be limiting.
As used herein, "immune stimulatory nucleic acid" and, equivalently,
"immunostimulatory nucleic acid" shall refer to a ribonucleic acid or deoxyribonucleic acid
molecule, derivative or analog thereof, characterized by its capacity to induce a functional
aspect of a cell of the immune system. Such functional aspect of a cell of the immune system
can include, for example, elaboration of a cytokine or chemokine, expression of a cell surface
marker, secretion of an antibody, proliferation, or other activity in response to or directed
against an antigen or antigen-bearing membrane-bound target.
For use in the instant invention, the nucleic acids of the invention can be synthesized
de novo using any of a number of procedures well known in the art, for example, the
ß-cyanoethyl phosphoramidite method (Beaucage SL and Caruthers MH (1981) Tetrahedron
Lett 22:1859); and the nucleoside H-phosphonate method (Garegg et al. (1986) Tetrahedron
Lett 27:4051-4; Froehler et al. (1986) Nucl Acid Res 14:5399-407; Garegg et al. (1986)
Tetrahedron Lett 27:4055-8; Gaffney et al. (1988) Tetrahedron Lett 29:2619-22). These
chemistries can be performed by a variety of automated nucleic acid synthesizers available in
the market. These nucleic acids are referred to as synthetic nucleic acids. Alternatively,
nucleic acids of the invention can be produced on a large scale in plasmids, (see Sambrook T
et al., "Molecular Cloning: A Laboratory Manual", Cold Spring Harbor Laboratory Press,
New York, 1989) and separated into smaller pieces or administered whole. Nucleic acids can
be prepared from existing nucleic acid sequences (e.g., genomic or cDNA) using known
techniques, such as those employing restriction enzymes, exonucleases or endonucleases.
Nucleic acids prepared in this manner are referred to as isolated nucleic acids. An isolated
nucleic acid generally refers to a nucleic acid which is separated from components which it is
normally associated with in nature. As an example, an isolated nucleic acid may be one
which is separated from a cell, from a nucleus, from mitochondria or from chromatin. The
combination motif nucleic acids of the instant invention encompass both synthetic and
isolated combination motif nucleic acids.
For use in vivo, the combination motif immunostimulatory nucleic acids may
optionally be relatively resistant to degradation (e.g., are stabilized). A "stabilized nucleic
acid molecule" shall mean a nucleic acid molecule that is relatively resistant to in vivo

degradation (e.g., via an exonuclease or endonuclease). Nucleic acid stabilization can be
accomplished via phosphate backbone modifications. Preferred stabilized nucleic acids of
the instant invention have a modified backbone. It has been demonstrated that modification
of the nucleic acid backbone provides enhanced activity of the combination motif
immunostimulatory nucleic acids when administered in vivo. Combination motif
immunostimulatory nucleic acids having phosphorothioate linkages in some instances
provide maximal activity and protect the nucleic acid from degradation by intracellular
exonucleases and endonucleases. Other modified nucleic acids include modified
phosphodiester nucleic acids, combinations of phosphodiester and phosphorothioate nucleic
acids (i.e., chimeric), methylphosphonate, methylphosphorothioate, phosphorodithioate, p-
ethoxy, and combinations thereof.
Modified backbones such as phosphorothioates may be synthesized using automated
techniques employing either phosphoramidate or H-phosphonate chemistries. Aryl-and
alkyl-phosphonates can be made, e.g., as described in U.S. Patent No. 4,469,863; and
alkylphosphotriesters (in which the charged oxygen moiety is alkylated as described in U.S.
Patent No. 5,023,243 and European Patent No. 092,574) can be prepared by automated solid
phase synthesis using commercially available reagents. Methods for making other DNA
backbone modifications and substitutions have been described. Uhlmann E and Peyman A
(1990) Chem Rev 90:544; Goodchild J (1990) Bioconjugate Chem 1:165.
Other stabilized nucleic acids include: nonionic DNA analogs, such as alkyl- and aryl-
phosphates (in which the charged phosphonate oxygen is replaced by an alkyl or aryl group),
phosphodiester and alkylphosphotriesters, in which the charged oxygen moiety is alkylated.
Nucleic acids which contain diol, such as tetraethyleneglycol or hexaethyleneglycol, at either
or both termini have also been shown to be substantially resistant to nuclease degradation.
In other embodiments the immunostimulatory nucleic acids may have phosphodiester
or chimeric e.g., soft or semi-soft backbones. A chimeric backbone includes a combination
of phosphodiester and modified backbone linkages. A chimeric oligonucleotide, for
instance, may be a soft oligonucleotide or a semi-soft oligonucleotide.
A soft oligonucleotide is an immunostimulatory oligonucleotide having a partially
stabilized backbone, in which phosphodiester or phosphodiester-like internucleoside linkages
occur only within and immediately adjacent to at least one internal pyrimidine nucleoside-
guanosine (YG) dinucleotide. The at least one internal YG dinucleotide itself has a

phosphodiester or phosphodiester-like intemucleoside linkage. A phosphodiester or
phosphodiester-like intemucleoside linkage occurring immediately adjacent to the at least one
internal YG dinucleotide can be 5', 3', or both 5' and 3' to the at least one internal YG
dinucleotide. Preferably a phosphodiester or phosphodiester-like intemucleoside linkage
occurring immediately adjacent to the at least one internal YG dinucleotide is itself an
internal intemucleoside linkage. Thus for a sequence N1YGN2, wherein N1 and N2 are each,
independent of the other, any single nucleotide, the YG dinucleotide has a phosphodiester or
phosphodiester-like intemucleoside linkage, and in addition (a) N1 and Y are linked by a
phosphodiester or phosphodiester-like intemucleoside linkage when N1 is an internal
nucleotide, (b) G and N2 are linked by a phosphodiester or phosphodiester-like
intemucleoside linkage when N2 is an internal nucleotide, or (c) N1 and Y are linked by a
phosphodiester or phosphodiester-like intemucleoside linkage when N1 is an internal
nucleotide and G and N2 are linked by a phosphodiester or phosphodiester-like
intemucleoside linkage when N2 is an internal nucleotide.
A semi-soft oligonucleotide is an immunostimulatory oligonucleotide having a
partially stabilized backbone, in which phosphodiester or phosphodiester-like intemucleoside
linkages occur only within at least one internal pyrimidine nucleoside-guanosine (YG)
dinucleotide. Semi-soft oligonucleotides can have a number of advantages over
immunostimulatory oligonucleotides with fully stabilized backbones. For instance, semi-soft
oligonucleotides may possess increased immunostimulatory potency relative to
corresponding fully stabilized immunostimulatory oligonucleotides.
The immunostimulatory nucleic acids may be used to treat a subject to induce an
immune response or treat an immune related disease such as, for example, infectious disease,
cancer, and allergic disorders. As used herein, "subject" shall refer to a human or vertebrate
animal including, but not limited to, a dog, cat, horse, cow, pig, sheep, goat, chicken,
monkey, rabbit, rat, mouse, etc.
As used herein, the terms "treat", "treating" and "treated" shall refer to a prophylactic
treatment which increases the resistance of a subject to developing a disease or, in other
words, decreases the likelihood that the subject will develop a disease or slows the
development of the disease, as well as to a treatment after the subject has developed the
disease in order to fight the disease, e.g., reduce or eliminate it altogether or prevent it from
becoming worse. For example, when used with respect to the treatment of an infectious

disease the terms refer to a prophylactic treatment which increases the resistance of a subject
to a microorganism or, in other words, decreases the likelihood that the subject will develop
an infectious disease to the microorganism, as well as to a treatment after the subject has been
infected in order to fight the infectious disease, e.g., reduce or eliminate it altogether or
prevent it from becoming worse. When used with respect to a disease such as cancer the
terms refer to the prevention or delay of the development of a cancer, reducing the symptoms
of cancer, and/or inhibiting or slowing the growth of an established cancer.
Thus, the nucleic acids are useful as prophylactics for the induction of immunity of a
subject at risk of developing an infection with an infectious organism or a subject at risk of
developing an allergic disorder or cancer. A "subject at risk" as used herein is a subject who
has any risk of exposure to an infection-causing infectious pathogen, exposure to an allergen,
or developing cancer. For instance, a subject at risk may be a subject who is planning to
travel to an area where a particular type of infectious agent or allergen is found or it may be a
subject who through lifestyle or medical procedures is exposed to bodily fluids which may
contain infectious organisms or even any subject living in an area that an infectious organism
or an allergen has been identified and is exposed directly to the infectious agent or allergen.
It also may be a subject at risk of biowarfare such as military personnel or those living in
areas at risk of terrorist attack. Subjects at risk of developing infection also include general
populations to which a medical agency recommends vaccination with a particular infectious
organism antigen. If the antigen is an allergen and the subject develops allergic responses to
that particular antigen and the subject is exposed to the antigen, i.e., during pollen season,
then that subject is at risk of exposure to the antigen. Subjects at risk of developing cancer
include those with a genetic predisposition or previously treated for cancer, and those
exposed to carcinogens such as tobacco, asbestos, and other chemical toxins or excessive
sunlight and other types of radiation. The nucleic acids are also useful as therapeutics in the
treatment of infectious disease, cancer and allergic disorders.
A "subject having an infection" is a subject that has been exposed to an infectious
pathogen and has acute or chronic detectable levels of the pathogen in the body. The nucleic
acids can be used alone, or in conjunction with other therapeutic agents such as an antigen or
an antimicrobial medicament to mount an immune response that is capable of reducing the
level of or eradicating the infectious pathogen. The method entails administering to a subject
having or at risk of developing an infection an effective amount of a combination motif

immune stimulatory nucleic acid of the invention to treat the infection. The method can be
used to treat viral, bacterial, fungal, and parasitic infections in human and non-human
vertebrate subjects.
As used herein, "infection" and, equivalently, "infectious disease" shall refer to a
disease arising from the presence of a foreign microorganism in the body of a subject. A
foreign microorganism may be a virus, a bacterium, a fungus, or a parasite.
Examples of infectious viruses include: Retroviridae (e.g., human immunodeficiency
viruses, such as HIV-1 (also referred to as HTLV-III, LAV or HTLV-III/LAV, or HIV-III;
and other isolates, such as HIV-LP; Picornaviridae (e.g., polio viruses, hepatitis A virus;
enteroviruses, human coxsackie viruses, rhinoviruses, echoviruses); Calciviridae (e.g., strains
that cause gastroenteritis); Togaviridae (e.g., equine encephalitis viruses, rubella viruses);
Flaviridae (e.g., dengue viruses, encephalitis viruses, yellow fever viruses); Coronaviridae
(e.g., coronaviruses); Rhabdoviridae (e.g., vesicular stomatitis viruses, rabies viruses);
Filoviridae (e.g., ebola viruses); Paramyxoviridae (e.g., parainfluenza viruses, mumps virus,
measles virus, respiratory syncytial virus); Orthomyxoviridae (e.g., influenza viruses);
Bungaviridae (e.g., Hantaan viruses, bunga viruses, phleboviruses and Nairo viruses); Arena
viridae (hemorrhagic fever viruses); Reoviridae (e.g., reoviruses, orbiviurses and rotaviruses);
Birnaviridae; Hepadnaviridae (Hepatitis B virus); Parvoviridae (parvoviruses);
Papovaviridae (papilloma viruses, polyoma viruses); Adenoviridae (most adenoviruses);
Herpesviridae (herpes simplex virus (HSV) 1 and 2, varicella zoster virus, cytomegalovirus
(CMV), herpes viruses); Poxviridae (variola viruses, vaccinia viruses, pox viruses); and
Iridoviridae (e.g., African swine fever virus); and unclassified viruses (e.g., the etiological
agents of Spongiform encephalopathies, the agent of delta hepatitis (thought to be a defective
satellite of hepatitis B virus), the agents of non-A, non-B hepatitis (class 1 = internally
transmitted; class 2 = parenterally transmitted (i.e., Hepatitis C); Norwalk and related viruses,
and astroviruses).
Examples of infectious bacteria include: Actinomyces israelii, Bacillus anthracis,
Bacteroides spp., Borrelia burgdorferi, Chlamydia trachomalis, Clostridium perfringens,
Clostridium letani, Corynebacterium diphlheriae, Corynebacterium spp., Enterobacter
aerogenes, Enterococcus sp., Erysipelothrix rhusiopathiae, Fusobacterium nucleatum,
Haemophilus influenzae, Helicobacter pyloris, Klebsiella pneumoniae, Legionella
pneumophilia, Leptospira, Listeria monocytogenes, Mycobacteria spp. (e.g., M. tuberculosis,

M. avium, M. intracellulare, M. kansasii, M. gordonae), Neisseria gonorrhoeas, Neisseria
meningitidis, Pasture!la multocida, pathogenic Campylobacter sp., Staphylococcus aureus,
Streptobacillus moniliformis. Streptococcus (anaerobic spp.), Streptococcus (viridans group),
Streptococcus agalactiae (Group B Streptococcus), Streptococcus bovis, Streptococcus
faecalis. Streptococcus pneumoniae, Streptococcus pyogenes (Group A Streptococcus),
Treponema pallidium, and Treponema pertenue.
Examples of infectious fungi include: Candida albicans, Cryptococcus neoformans,
Histoplasma capsulatum, Coccidioides immitis, and Blastomyces dermatitidis.
Other infectious organisms (i.e., protists) include Plasmodium spp. such as
Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, and Plasmodium vivax,
and Toxoplasma gondii. Blood-borne and/or tissue parasites include Plasmodium spp.,
Babesia microti, Babesia divergem, Leishmania tropica, Leishmania spp., Leishmania
braziliensis, Leishmania donovani, Trypanosoma gambiense and Trypanosoma rhodesiense
(African sleeping sickness), Trypanosoma cruzi (Chagas' disease), and Toxoplasma gondii.
The foregoing lists of viruses, bacteria, fungi, and other infectious microorganisms is
understood to be representative and not limiting. Other medically relevant microorganisms
have been described extensively in the literature, e.g., see C.G.A Thomas, Medical
Microbiology, Bailliere Tindall, Great Britain 1983, the entire contents of which is hereby
incorporated by reference.
Although many of the microbial agents described above relate to human disorders, the
invention is also useful for treating non-human vertebrates. Non-human vertebrates are also
capable of developing infections which can be prevented or treated with the
immunostimulatory nucleic acids disclosed herein. For instance, in addition to the treatment
of infectious human diseases, the methods of the invention are useful for treating infections
of animals.
Infectious viruses of both human and non-human vertebrates include retroviruses,
RNA viruses and DNA viruses. This group of retroviruses includes both simple retroviruses
and complex retroviruses. The simple retroviruses include the subgroups of B-type
retroviruses, C-type retroviruses and D-type retroviruses. An example of a B-type retrovirus
is mouse mammary tumor virus (MMTV). The C-type retroviruses include subgroups C-type
group A (including Rous sarcoma virus (RSV), avian leukemia virus (ALV), and avian
myeloblastosis virus (AMV)) and C-type group B (including feline leukemia virus (FeLV),

gibbon ape leukemia virus (GALV), spleen necrosis virus (SNV), reticuloendotheliosis virus
(RV) and simian sarcoma virus (SSV)). The D-type retroviruses include Mason-Pfizer
monkey virus (MPMV) and simian retrovirus type 1 (SRV-1). The complex retroviruses
include the subgroups of lentiviruses, T-cell leukemia viruses and the foamy viruses.
Lentiviruses include HIV-1, but also include HIV-2, SIV, Visna virus, feline
immunodeficiency virus (FIV), and equine infectious anemia virus (EIAV). The T-cell
leukemia viruses include HTLV-1, HTLV-1I, simian T-cell leukemia virus (STLV), and
bovine leukemia virus (BLV). The foamy viruses include human foamy virus (HFV), simian
foamy virus (SFV) and bovine foamy virus (BFV).
Examples of other RNA viruses that are infectious agents in vertebrate animals
include, but are not limited to, members of the family Reoviridae, including the genus
Orthoreovirus (multiple serotypes of both mammalian and avian retroviruses), the genus
Orbivirus (Bluetongue virus, Eugenangee virus, Kemerovo virus, African horse sickness
virus, and Colorado Tick Fever virus), the genus Rotavirus (human rotavirus, Nebraska calf
diarrhea virus, simian rotavirus, bovine or ovine rotavirus, avian rotavirus); the family
Picornaviridae, including the genus Enterovirus (poliovirus, Coxsackie virus A and B,
enteric cytopathic human orphan (ECHO) viruses, hepatitis A virus, Simian enteroviruses,
Murine encephalomyelitis (ME) viruses, Poliovirus muris, Bovine enteroviruses, Porcine
enteroviruses, the genus Cardiovirus (Encephalomyocarditis virus (EMC), Mengovirus), the
genus Rhinovirus (Human rhinoviruses including at least 113 subtypes; other rhinoviruses),
the genus Apthovirus (Foot and Mouth disease virus (FMDV); the family Calciviridae,
including Vesicular exanthema of swine virus, San Miguel sea lion virus, Feline picornavirus
and Norwalk virus; the family Togaviridae, including the genus Alphavirus (Eastern equine
encephalitis virus, Semliki forest virus, Sindbis virus, Chikungunya virus, O'Nyong-Nyong
virus, Ross river virus, Venezuelan equine encephalitis virus, Western equine encephalitis
virus), the genus Flavivirus (Mosquito-borne yellow fever virus, Dengue virus, Japanese
encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, West Nile
virus, Kunjin virus, Central European tick borne virus, Far Eastern tick borne virus, Kyasanur
forest virus, Louping III virus, Powassan virus, Omsk hemorrhagic fever virus), the genus
Rubivirus (Rubella virus), the genus Pestivirus (Mucosal disease virus, Hog cholera virus,
Border disease virus); the family Bunyaviridae, including the genus Bunyvirus (Bunyamwera
and related viruses, California encephalitis group viruses), the genus Phlebovirus (Sandfly

fever Sicilian virus, Rift Valley fever virus), the genus Nairovirus (Crimean-Congo
hemorrhagic fever virus, Nairobi sheep disease virus), and the genus Uukuvirus (Uukuniemi
and related viruses); the family Orthomyxoviridae, including the genus Influenza virus
(Influenza virus type A, many human subtypes); Swine influenza virus, and Avian and
Equine Influenza viruses; influenza type B (many human subtypes), and influenza type C
(possible separate genus); the family paramyxoviridae, including the genus Paramyxovirus
(Parainfluenza virus type 1, Sendai virus, Hemadsorption virus, Parainfluenza viruses types 2
to 5, Newcastle Disease Virus, Mumps virus), the genus Morbillivirus (Measles virus,
subacute sclerosing panencephalitis virus, distemper virus, Rinderpest virus), the genus
Pneumovirus (respiratory syncytial virus (RSV), Bovine respiratory syncytial virus and
Pneumonia virus); the family Rhabdovihdae, including the genus Vesiculovirus (VSV),
Chandipura virus, Flanders-Hart Park virus), the genus Lyssavirus (Rabies virus), fish
Rhabdoviruses, and two probable Rhabdoviruses (Marburg virus and Ebola virus); the family
Arenaviridae, including Lymphocytic choriomeningitis virus (LCM), Tacaribe virus
complex, and Lassa virus; the family Coronoaviridae, including Infectious Bronchitis Virus
(IBV), Hepatitis virus, Human enteric corona virus, and Feline infectious peritonitis (Feline
coronavirus).
Illustrative DNA viruses that are infectious agents in vertebrate animals include, but
are not limited to, the family Poxviridae, including the genus Orthopoxvirus (Variola major,
Variola minor, Monkey pox Vaccinia, Cowpox, Buffalopox, Rabbitpox, Ectromelia), the
genus Leporipoxvirus (Myxoma, Fibroma), the genus Avipoxvirus (Fowlpox, other avian
poxvirus), the genus Capripoxvirus (sheep-pox, goatpox), the genus Suipoxvirus (Swinepox),
the genus Parapoxvirus (contagious pustular dermatitis virus, pseudocowpox, bovine papular
stomatitis virus); the family Iridoviridae (African swine fever virus, Frog viruses 2 and 3,
Lymphocystis virus offish); the family Herpesviridae, including the alpha-Herpesviruses
(Herpes Simplex Types 1 and 2, Varicella-Zoster, Equine abortion virus, Equine herpes virus
2 and 3, pseudorabies virus, infectious bovine keratoconjunctivitis virus, infectious bovine
rhinotracheitis virus, feline rhinotracheitis virus, infectious laryngotracheitis virus), the
Beta-herpesviruses (Human cytomegalovirus and cytomegaloviruses of swine and monkeys);
the gamma-herpesviruses (Epstein-Barr virus (EBV), Marek's disease virus, Herpes saimiri,
Herpesvirus ateles, Herpesvirus sylvilagus, guinea pig herpes virus, Lucke tumor virus); the
family Adenoviridae, including the genus Mastadenovirus (Human subgroups A, B, C, D, E

and ungrouped; simian adenoviruses (at least 23 serotypes), infectious canine hepatitis, and
adenoviruses of cattle, pigs, sheep, frogs and many other species, the genus Aviadenovirus
(Avian adenoviruses); and non-cultivatable adenoviruses; the family Papoviridae, including
the genus Papillomavirus (Human papilloma viruses, bovine papilloma viruses, Shope rabbit
papilloma virus, and various pathogenic papilloma viruses of other species), the genus
Polyomavirus (polyomavirus, Simian vacuolating agent (SV-40), Rabbit vacuolating agent
(RKV), K virus, BK virus, JC virus, and other primate polyoma viruses such as
Lymphotrophic papilloma virus); the family Parvoviridae including the genus
Adeno-associated viruses, the genus Parvovirus (Feline panleukopenia virus, bovine
parvovirus, canine parvovirus, Aleutian mink disease virus, etc). Finally, DNA viruses may
include viruses which do not fit into the above families, such as Kuru and Creutzfeldt-Jacob
disease viruses and chronic infectious neuropathic agents (CHINA virus).
The nucleic acids may be administered to a subject with an anti-microbial agent. An
anti-microbial agent, as used herein, refers to a naturally-occurring, synthetic, or semi-
synthetic compound which is capable of killing or inhibiting infectious microorganisms. The
type of anti-microbial agent useful according to the invention will depend upon the type of
microorganism with which the subject is infected or at risk of becoming infected. Antimicrobial
agents include but are not limited to anti-bacterial agents, anti-viral agents, anti-
fungal agents and anti-parasitic agents. Phrases such as "anti-infective agent", "anti-bacterial
agent", "anti-viral agent", "anti-fungal agent", "anti-parasitic agent" and "parasiticide" have
well-established meanings to those of ordinary skill in the art and are defined in standard
medical texts. Briefly, anti-bacterial agents kill or inhibit bacteria, and include antibiotics as
well as other synthetic or natural compounds having similar functions. Antibiotics are low
molecular weight molecules which are produced as secondary metabolites by cells, such as
microorganisms. In general, antibiotics interfere with one or more bacterial functions or
structures which are specific for the microorganism and which are not present in host cells.
Anti-viral agents can be isolated from natural sources or synthesized and are useful for killing
or inhibiting viruses. Anti-fungal agents are used to treat superficial fungal infections as well
as opportunistic and primary systemic fungal infections. Anti-parasite agents kill or inhibit
parasites.
Antibacterial agents kill or inhibit the growth or function of bacteria. A large class of
antibacterial agents is antibiotics. Antibiotics, which are effective for killing or inhibiting a

wide range of bacteria, are referred to as broad spectrum antibiotics. Other types of
antibiotics are predominantly effective against the bacteria of the class gram-positive or
gram-negative. These types of antibiotics are referred to as narrow spectrum antibiotics.
Other antibiotics which are effective against a single organism or disease and not against
other types of bacteria, are referred to as limited spectrum antibiotics. Antibacterial agents
are sometimes classified based on their primary mode of action. In general, antibacterial
agents are cell wall synthesis inhibitors, cell membrane inhibitors, protein synthesis
inhibitors, nucleic acid synthesis or functional inhibitors, and competitive inhibitors.
Antiviral agents are compounds which prevent infection of cells by viruses or
replication of the virus within the cell. There are many fewer antiviral drugs than
antibacterial drugs because the process of viral replication is so closely related to DNA
replication within the host cell, that non-specific antiviral agents would often be toxic to the
host. There are several stages within the process of viral infection which can be blocked or
inhibited by antiviral agents. These stages include, attachment of the virus to the host cell
(immunoglobulin or binding peptides), uncoating of the virus (e.g., amantadine), synthesis or
translation of viral mRNA (e.g., interferon), replication of viral RNA or DNA (e.g.,
nucleoside analogues), maturation of new virus proteins (e.g., protease inhibitors), and
budding and release of the virus.
Nucleotide analogues are synthetic compounds which are similar to nucleotides, but
which have an incomplete or abnormal deoxyribose or ribose group. Once the nucleotide
analogues are in the cell, they are phosphorylated, producing the triphosphate formed which
competes with normal nucleotides for incorporation into the viral DNA or RNA. Once the
triphosphate form of the nucleotide analogue is incorporated into the growing nucleic acid
chain, it causes irreversible association with the viral polymcrase and thus chain termination.
Nucleotide analogues include, but are not limited to, acyclovir (used for the treatment of
herpes simplex virus and varicella-zoster virus), gancyclovir (useful for the treatment of
cytomegalovirus), idoxuridine, ribavirin (useful for the treatment of respiratory syncitial
virus), dideoxyinosine, dideoxycytidine, and zidovudine (azidothymidine).
Anti-fungal agents are useful for the treatment and prevention of infective fungi.
Anti-fungal agents are sometimes classified by their mechanism of action. Some anti-fungal
agents function as cell wall inhibitors by inhibiting glucose synthase. These include, but are
not limited to, basiungin/ECB. Other anti-fungal agents function by destabilizing membrane

integrity. These include, but are not limited to, immidazoles, such as clotrimazole,
sertaconzole, fluconazole, itraconazole, ketoconazole, miconazole, and voriconacole, as well
as FK 463, amphotericin B, BAY 38-9502, MK 991, pradimicin, UK 292, butenafine, and
terbinafine. Other anti-fungal agents function by breaking down chitin (e.g., chitinase) or
immunosuppression (501 cream).
The immunostimulatory nucleic acids may be used, either alone or in combination
with an anti-cancer therapy, for the treatment of cancer. The method entails administering to
a subject having or at risk of developing cancer an effective amount of a combination motif
immune stimulatory nucleic acid of the invention to treat cancer.
A "subject having a cancer" is a subject that has detectable cancerous cells. The
cancer may be a malignant or non-malignant cancer. Cancers or tumors include but are not
limited to biliary tract cancer; brain cancer; breast cancer; cervical cancer; choriocarcinoma;
colon cancer; endometrial cancer; esophageal cancer; gastric cancer; intraepithelial
neoplasms; lymphomas; liver cancer; lung cancer (e.g., small cell and non-small cell);
melanoma; neuroblastomas; oral cancer; ovarian cancer; pancreas cancer; prostate cancer;
rectal cancer; sarcomas; skin cancer; testicular cancer; thyroid cancer; and renal cancer, as
well as other carcinomas and sarcomas. In one embodiment the cancer is hairy cell leukemia,
chronic myelogenous leukemia, cutaneous T-cell leukemia, multiple myeloma, follicular
Iymphoma, malignant melanoma, squamous cell carcinoma, renal cell carcinoma, prostate
carcinoma, bladder cell carcinoma, or colon carcinoma.
Cancer is one of the leading causes of death in companion animals (i.e., cats and
dogs). Malignant disorders commonly diagnosed in dogs and cats include but are not limited
to lymphosarcoma, osteosarcoma, mammary tumors, mastocytoma, brain tumor, melanoma,
adenosquamous carcinoma, carcinoid lung tumor, bronchial gland tumor, bronchiolar
adenocarcinoma, fibroma, myxochondroma, pulmonary sarcoma, neurosarcoma, osteoma,
papilloma, retinoblastoma, Ewing's sarcoma, Wilms' tumor, Burkitt's lymphoma,
microglioma, neuroblastoma, osteoclastoma, oral neoplasia, fibrosarcoma, osteosarcoma and
rhabdomyosarcoma. Other neoplasms in dogs include genital squamous cell carcinoma,
transmissible venereal tumor, testicular tumor, seminoma, Sertoli cell tumor,
hemangiopericytoma, histiocytoma, chloroma (granulocytic sarcoma), corneal papilloma,
corneal squamous cell carcinoma, hemangiosarcoma, pleural mesothelioma, basal cell tumor,
thymoma, stomach tumor, adrenal gland carcinoma, oral papillomatosis,

hemangioendothelioma and cystadenoma. Additional malignancies diagnosed in cats include
follicular lymphoma, intestinal lymphosarcoma, fibrosarcoma and pulmonary squamous cell
carcinoma. The ferret, an ever-more popular house pet, is known to develop insulinoma,
lymphoma, sarcoma, neuroma, pancreatic islet cell tumor, gastric MALT lymphoma and
gastric adenocarcinoma.
The immunostimulatory nucleic acids may also be administered in conjunction with
an anti-cancer therapy. Anti-cancer therapies include cancer medicaments, radiation and
surgical procedures. As used herein, a "cancer medicament" refers to an agent which is
administered to a subject for the purpose of treating a cancer. Various types of medicaments
for the treatment of cancer are described herein. For the purpose of this specification, cancer
medicaments are classified as chemotherapeutic agents, immunotherapeutic agents, cancer
vaccines, hormone therapy, and biological response modifiers.
The use of immunostimulatory nucleic acids in conjunction with immunotherapeutic
agents such as monoclonal antibodies is able to increase long-term survival through a number
of mechanisms including significant enhancement of antibody-dependent cellular cytotoxicity
(ADCC), activation of NK cells and an increase in IFN-a levels. ADCC can be performed
using an immunostimulatory nucleic acid in combination with an antibody specific for a
cellular target, such as a cancer cell. When the immunostimulatory nucleic acid is
administered to a subject in conjunction with the antibody the subject's immune system is
induced to kill the tumor cell. The antibodies useful in the ADCC procedure include
antibodies which interact with a cell in the body. Many such antibodies specific for cellular
targets have been described in the art and many are commercially available. The nucleic
acids when used in combination with monoclonal antibodies serve to reduce the dose of the
antibody required to achieve a biological result.
Other types of chemotherapeutic agents which can be used according to the invention
include Aminoglutethimide, Asparaginase, Busulfan, Carboplatin, Chlorombucil, Cytarabine
HC1, Dactinomycin, Daunorubicin HC1, Estramustine phosphate sodium, Etoposide (VP16-
213), Floxuridine, Fluorouracil (5-FU), Flutamide, Hydroxyurea (hydroxycarbamide),
Ifosfamide, Interferon Alfa-2a, Alfa-2b, Leuprolide acetate (LHRH-releasing factor
analogue), Lomustine (CCNU), Mechlorethamine HC1 (nitrogen mustard), Mercaptopurine,
Mesna, Mitotane (o.p'-DDD), Mitoxantrone HC1, Octreotide, Plicamycin, Procarbazine HC1,
Streptozocin, Tamoxifen citrate, Thioguanine, Thiotepa, Vinblastine sulfate, Amsacrine (m-

AMSA), Azacitidine, Erythropoietin, Hexamethylmelamine (HMM), Interleukin 2,
Mitoguazone (methyl-GAG; methyl glyoxal bis-guanylhydrazone; MGBG), Pentostatin
(2'deoxycoformycin), Semustine (methyl-CCNU), Teniposide (VM-26) and Vindesine
sulfate.
Cancer vaccines are medicaments which are intended to stimulate an endogenous
immune response against cancer cells. Currently produced vaccines predominantly activate
the humoral immune system (i.e., the antibody dependent immune response). Other vaccines
currently in development are focused on activating the cell-mediated immune system
including cytotoxic T lymphocytes which are capable of killing tumor cells. Cancer vaccines
generally enhance the presentation of cancer antigens to both antigen presenting cells (e.g.,
macrophages and dendritic cells) and/or to other immune cells such as T cells, B cells, and
NK cells. In some instances, cancer vaccines may be used along with adjuvants, such as
those described above.
Some cancer cells are antigenic and thus can be targeted by the immune system. In
one aspect, the combined administration of immunostimulatory nucleic acids and cancer
medicaments, particularly those which are classified as cancer immunotherapies, is useful for
stimulating a specific immune response against a cancer antigen, used herein, the terms
"cancer antigen" and "tumor antigen" are used, interchangeably to refer to antigens which are
differentially expressed by cancer cells and can thereby be exploited in order to target cancer
cells. Cancer antigens are antigens which can potentially stimulate apparently tumor-specific
immune responses. Some of these antigens are encoded, although not necessarily expressed,
by normal cells. These antigens can be characterized as those which are normally silent (i.e.,
not expressed) in normal cells, those that are expressed only at certain stages of
differentiation and those that are temporally expressed such as embryonic and fetal antigens.
Other cancer antigens are encoded by mutant cellular genes, such as oncogenes (e.g.,
activated ras oncogene), suppressor genes (e.g., mutant p53), fusion proteins resulting from
internal deletions or chromosomal translocations. Still other cancer antigens can be encoded
by viral genes such as those carried on RNA and DNA tumor viruses. "Tumor-associated"
antigens are present in both tumor cells and normal cells but are present in a different
quantity or a different form in tumor cells. Examples of such antigens are oncofetal antigens
(e.g., carcinoembryonic antigen), differentiation antigens (e.g., T and Tn antigens), and
oncogene products (e.g., HER/neu).

Cancer antigens, such as those present in cancer vaccines or those used to prepare
cancer immunotherapies, can be prepared from crude cancer cell extracts, as described in
Cohen PA et al. (1994) Cancer Res 54:1055-8, or by partially purifying the antigens, using
recombinant technology, or de novo synthesis of known antigens. Cancer antigens can be
used in the form of immunogenic portions of a particular antigen or in some instances a
whole cell or a tumor mass can be used as the antigen. Such antigens can be isolated or
prepared recombinantly or by any other means known in the art.
Other vaccines take the form of dendritic cells which have been exposed to cancer
antigens in vitro, have processed the antigens and are able to express the cancer antigens at
their cell surface in the context of MHC molecules for effective antigen presentation to other
immune system cells. Dendritic cells form the link between the innate and the acquired
immune system by presenting antigens and through their expression of pattern recognition
receptors which detect microbial molecules like LPS in their local environment.
The combination motif immunostimulatory nucleic acids are useful for the treatment
of allergy, including asthma. The combination motif immune stimulatory nucleic acids can
be used, either alone or in combination with an allergy/asthma medicament, to treat allergy.
The method entails administering to a subject having or at risk of developing an allergic or
asthmatic condition an effective amount of a combination motif immune stimulatory nucleic
acid of the invention to treat the allergic or asthmatic condition.
As used herein, "allergy" shall refer to acquired hypersensitivity to a substance
(allergen). Allergic conditions include eczema, allergic rhinitis or coryza, hay fever,
bronchial asthma, urticaria (hives) and food allergies, and other atopic conditions. A "subject
having an allergy" is a subject that has or is at risk of developing an allergic reaction in
response to an allergen. An "allergen" refers to a substance that can induce an allergic or
asthmatic response in a susceptible subject. The list of allergens is enormous and can include
pollens, insect venoms, animal dander, dust, fungal spores and drugs (e.g., penicillin).
Examples of natural animal and plant allergens include proteins specific to the
following genuses: Canine (Canis familiaris); Dermatophagoides (e.g., Dermatophagoides
farinae); Felis (Felis domesticus); Ambrosia (Ambrosia artemiisfolia; Lolium (e.g., Lolium
perenne or Lolium multiflorum); Cryptomeria (Cryptomeriajaponica); Alternaria (Alternaria
alternata); Alder; Alnus (Alnus gultinosa); Betula (Betula verrucosa); Quercus (Quercus
alba); Olea (Olea europa); Artemisia (Artemisia vulgaris); Plantago (e.g., Plantago

lanceolata); Parielaria (e.g., Parietaria officinalis or Parietaria judaica); Blattella (e.g.,
Blattella germanica); Apis (e.g., Apis multiflorum); Cupressus (e.g., Cupressus sempervirens,
Cupressus arizonica and Cupressus macrocarpa); Juniperus (e.g., Juniperus sabinoides,
Juniperus virginiana, Juniperus communis and Juniperus ashei); Thuya (e.g., Thuya
orientalis); Chamaecyparis (e.g., Chamaecyparis obtusa); Periplaneta (e.g., Periplanela
americana); Agropyron (e.g., Agropyron repens); Secale (e.g., Secale cereale); Triticum
(e.g., Triticum aestivum); Dactylis (e.g., Dactylis glomerata); Festuca (e.g., Fesluca elatior);
Poa (e.g., .Poor pratensis or Poa compressa); Avena (e.g., Avena sativa); Holcus (e.g., Holcus
lanatus); Anthoxanthum (e.g., Anthoxanthum odoratum); Arrhenatherum (e.g.,
Arrhenatherum elatius); Agrostis (e.g., Agrostis alba); Phleum (e.g., Phleum pratense);
Phalaris (e.g., Phalaris arundinacea); Paspalum (e.g., Paspalum notatum); Sorghum (e.g.,
Sorghum halepensis); and Bromus (e.g., Bromus inermis).
As used herein, "asthma" shall refer to a disorder of the respiratory system
characterized by inflammation, narrowing of the airways and increased reactivity of the
airways to inhaled agents. Asthma is frequently, although not exclusively, associated with
atopic or allergic symptoms.
An "asthma/allergy medicament" as used herein is a composition of matter which
reduces the symptoms, inhibits the asthmatic or allergic reaction, or prevents the development
of an allergic or asthmatic reaction. Various types of medicaments for the treatment of
asthma and allergy are described in the Guidelines For The Diagnosis and Management of
Asthma, Expert Panel Report 2, NIH Publication No. 97/4051, July 19, 1997, the entire
contents of which are incorporated herein by reference. The summary of the medicaments as
described in the NIH publication is presented below.
In most embodiments the asthma/allergy medicament is useful to some degree for
treating both asthma and allergy. Some asthma/allergy medicaments are preferably used in
combination with the immunostimulatory nucleic acids to treat asthma. These are referred to
as asthma medicaments. Asthma medicaments include, but are not limited, PDE-4 inhibitors,
bronchodilator/beta-2 agonists, K+ channel openers, VLA-4 antagonists, neurokin
antagonists, TXA2 synthesis inhibitors, xanthanines, arachidonic acid antagonists, 5
lipoxygenase inhibitors, thromboxin A2 receptor antagonists, thromboxane A2 antagonists,
inhibitor of 5-lipoxygenase activation proteins, and protease inhibitors.

Other asthma/allergy medicaments are preferably used in combination with the
immunostimulatory nucleic acids to treat allergy. These are referred to as allergy
medicaments. Allergy medicaments include, but are not limited to, anti-histamines, steroids,
immunomodulators, and prostaglandin inducers. Anti-histamines are compounds which
counteract histamine released by mast cells or basophils. These compounds are well known
in the art and commonly used for the treatment of allergy. Anti-histamines include, but are
not limited to, loratidine, cetirizine, buclizine, ceterizine analogues, fexofenadine,
terfenadine, desloratadine, norastemizole, epinastine, ebastine, ebastine, astemizole,
levocabastine, azelastine, tranilast, terfenadine, mizolastine, betatastine, CS 560, and HSR
609. Prostaglandin inducers are compounds which induce prostaglandin activity.
Prostaglandins function by regulating smooth muscle relaxation. Prostaglandin inducers
include, but are not limited to, S-5751.
The steroids include, but are not limited to, beclomethasone, fluticasone,
tramcinolone, budesonide, corticosteroids and budesonide. The combination of
immunostimulatory nucleic acids and steroids are particularly well suited to the treatment of
young subjects (e.g., children). To date, the use of steroids in children has been limited by
the observation that some steroid treatments have been reportedly associated with growth
retardation. Thus, according to the present invention, the immunostimulatory nucleic acids
can be used in combination with growth retarding steroids, and can thereby provide a "steroid
sparing effect." The combination of the two agents can result in lower required doses of
steroids.
The immunomodulators include, but are not limited to, the group consisting of anti-
inflammatory agents, leukotriene antagonists, IL-4 muteins, soluble IL-4 receptors,
immunosuppressants (such as tolerizing peptide vaccine), anti-IL-4 antibodies, IL-4
antagonists, anti-IL-5 antibodies, soluble IL-13 receptor-Fc fusion proteins, anti-IL-9
antibodies, CCR3 antagonists, CCR5 antagonists, VLA-4 inhibitors, and , and
downregulators of IgE.
The immunostimulatory nucleic acids of the invention can be used to induce type 1
IFN, i.e., IFN-a and IFN-ß. The method involves contacting a cell capable of expressing a
type 1 IFN with an effective amount of a combination motif immune stimulatory nucleic acid
of the invention to induce type 1 IFN expression by the cell. It has recently been appreciated
that the major producer cell type of IFN-a in humans is the plasmacytoid dendritic cell

(pDC). This type of cell occurs at very low frequency (0.2-0.4 percent) in PBMC and is
characterized by a phenotype that is lineage negative (i.e., does not stain for CD3, CD 14,
CD19, or CD56) and CD11c negative, while positive for CD4, CD123 (IL-3Ra), and class II
major histocompatibility complex (MHC class II). Grouard G et al. (1997) J Exp Med
185:1101-11; Rissoan M-C et al. (1999) Science 283:1183-6; Siegal FP et al. (1999) Science
284:1835-7; Cella M et al. (1999) Nat Med 5:919-23. Methods of measuring type 1 IFN are
well known by those skilled in the art, and they include, for example, enzyme-linked
immunosorbent assay (ELISA), bioassay, and fluorescence-activated cell sorting (FACS).
Assays of this sort can be performed using readily available commercial reagents and kits.
The immunostimulatory nucleic acids of the invention may be used to activate NK
cells. The method involves contacting an NK cell with an effective amount of a combination
motif immune stimulatory nucleic acid of the invention to activate the NK cell. The
activation of the NK cells may be direct activation or indirect activation. Indirect activation
refers to the induction of cytokines or other factors which cause the subsequent activation of
the NK cells. NK cell activation can be assessed by various methods, including
measurement of lytic activity, measurement of induction of activation markers such as CD69,
and measurement of induction of certain cytokines. In addition to their characteristic ability
to kill certain tumor targets spontaneously, NK cells participate in ADCC and are major
producers of IFN-?, TNF-a, GM-CSF and IL-3.
The prototypical NK-sensitive cell target for mouse NK cells is yeast artificial
chromosome (YAC)-1, a thymoma derived from Moloney virus-infected A strain mice. For
human NK cells, a standard target is K562, a cell line derived from an erythroleukemic
lineage. In microtiter plates, a constant number of radiolabeled targets (e.g., 5lCr-labeled
K562) is incubated either alone (spontaneous), with detergent (maximum), or with varying
numbers of effector cells (experimental). The ratio of effector to target cells is referred to as
the E.T ratio. Enriched, activated NK cells typically are effective at E:T ratios of less than
10:1, while unfractionated PBMCs or splenocytes require E:T ratios of 100:1 or more.
The immunostimulatory nucleic acids also are useful as adjuvants for inducing a
systemic and/or mucosal immune response. The combination motif immune stimulatory
nucleic acids of the invention can be delivered to a subject exposed to an antigen to produce
an enhanced immune response to the antigen. Thus for example combination motif immune
stimulatory nucleic acids are useful as vaccine adjuvants.

The immunostimulatory nucleic acids may be administered in combination with non-
nucleic acid adjuvants. A non-nucleic acid adjuvant is any molecule or compound except for
the immunostimulatory nucleic acids described herein which can stimulate the humoral
and/or cellular immune response. Non-nucleic acid adjuvants include, for instance, adjuvants
that create a depot effect, immune stimulating adjuvants, and adjuvants that create a depo
effect and stimulate the immune system. A non-nucleic acid mucosal adjuvant as used herein
is an adjuvant other than a immunostimulatory nucleic acid that is capable of inducing a
mucosal immune response in a subject when administered to a mucosal surface in
conjunction with an antigen.
The immunostimulatory nucleic acids of the invention may be formulated as
pharmaceutical compositions in a pharmaceutically acceptable carrier. The
immunostimulatory nucleic acids may be directly administered to the subject or may be
administered in conjunction with a nucleic acid delivery complex. A nucleic acid delivery
complex shall mean a nucleic acid molecule associated with (e.g., ionically or covalently
bound to; or encapsulated within) a targeting means (e.g., a molecule that results in higher
affinity binding to target cell (e.g., B-cell surfaces) and/or increased cellular uptake by target
cells). Examples of nucleic acid delivery complexes include nucleic acids associated with a
sterol (e.g., cholesterol), a lipid (e.g., a cationic Iipid, virosome or liposome), or a target cell
specific binding agent (e.g., a ligand recognized by target cell specific receptor). Preferred
complexes may be sufficiently stable in vivo to prevent significant uncoupling prior to
internalization by the target cell. However, the complex can be cleavable under appropriate
conditions within the cell so that the nucleic acid is released in a functional form.
The immunostimulatory nucleic acid and/or the antigen and/or other therapeutics may
be administered alone (e.g., in saline or buffer) or using any delivery vehicles known in the
art. For instance the following delivery vehicles have been described: Cochleates (Gould-
Fogerite et al., 1994, 1996); Emulsomes (Vancott et al., 1998, Lowell et al., 1997); ISCOMs
(Mowat et al., 1993, Carlsson et al., 1991, Hu et., 1998, Morein et al., 1999); Liposomes
(Childers et al., 1999, Michalek et al., 1989, 1992, de Haan 1995a, 1995b); Microspheres
(Gupta et al., 1998, Jones et al., 1996, Maloy et al., 1994, Moore et al., 1995, O'Hagan et al.,
1994, Eldridge et al., 1989); Polymers (e.g., carboxymethylcellulose, chitosan) (Hamajima et
al., 1998, Jabbal-Gill et al., 1998); Polymer rings (Wyatt et al., 1998); Proteosomes (Vancott
et al., 1998, Lowell et al., 1988, 1996, 1997); Virosomes (Gluck et al., 1992, Mengiardi et al.,

1995, Cryz et al., 1998); Virus-like particles (Jiang et al., 1999, Leibl et al., 1998). Other
delivery vehicles are known in the art.
Subject doses of the compounds described herein for mucosal or local delivery
typically range from about 0.1 µg to 10 mg per administration, which depending on the
application could be given daily, weekly, or monthly and any other amount of time
therebetween. More typically mucosal or local doses range from about 10 µg to 5 mg per
administration, and most typically from about 100 µg to 1 mg, with 2 - 4 administrations
being spaced days or weeks apart. More typically, immune stimulant doses range from 1 µg
to 10 mg per administration, and most typically 10 µg to 1 mg, with daily or weekly
administrations. Subject doses of the compounds described herein for parenteral delivery for
the purpose of inducing an antigen-specific immune response, wherein the compounds are
delivered with an antigen but not another therapeutic agent are typically 5 to 10,000 times
higher than the effective mucosal dose for vaccine adjuvant or immune stimulant
applications, and more typically 10 to 1,000 times higher, and most typically 20 to 100 times
higher. Doses of the compounds described herein for parenteral delivery for the purpose of
inducing an innate immune response or for increasing ADCC or for inducing an antigen
specific immune response when the immunostimulatory nucleic acids are administered in
combination with other therapeutic agents or in specialized delivery vehicles typically range
from about 0.1 µg to 10 mg per administration, which depending on the application could be
given daily, weekly, or monthly and any other amount of time therebetween. More typically
parenteral doses for these purposes range from about 10 µg to 5 mg per administration, and
most typically from about 100 µg to 1 mg, with 2-4 administrations being spaced days or
weeks apart. In some embodiments, however, parenteral doses for these purposes may be
used in a range of 5 to 10,000 times higher than the typical doses described above.
As used herein, "effective amount" shall refer to the amount necessary or sufficient to
realize a desired biological effect. For example, an effective amount of an
immunostimulatory nucleic acid for treating an infection is that amount necessary to treat the
infection. Combined with the teachings provided herein, by choosing among the various
active compounds and weighing factors such as potency, relative bioavailability, patient body
weight, severity of adverse side-effects and preferred mode of administration, an effective
prophylactic or therapeutic treatment regimen can be planned which does not cause
substantial toxicity and yet is entirely effective to treat the particular subject. The effective

amount for any particular application can vary depending on such factors as the disease or
condition being treated, the particular immunostimulatory nucleic acid being administered,
the antigen, the size of the subject, or the severity of the disease or condition. One of
ordinary skill in the art can empirically determine the effective amount of a particular
immunostimulatory nucleic acid and/or antigen and/or other therapeutic agent without
necessitating undue experimentation.
For any compound described herein the therapeutically effective amount can be
initially determined from animal models. A therapeutically effective dose can also be
determined from human data for CpG oligonucleotides which have been tested in humans
(human clinical trials have been initiated) and for compounds which are known to exhibit
similar pharmacological activities, such as other mucosal adjuvants, e.g., LT and other
antigens for vaccination purposes, for the mucosal or local administration. Higher doses are
required for parenteral administration. The applied dose can be adjusted based on the relative
bioavailability and potency of the administered compound. Adjusting the dose to achieve
maximal efficacy based on the methods described above and other methods as are well-
known in the art is well within the capabilities of the ordinarily skilled artisan.
The formulations of the invention are administered in pharmaceutically acceptable
solutions, which may routinely contain pharmaceutically acceptable concentrations of salt,
buffering agents, preservatives, compatible carriers, adjuvants, and optionally other
therapeutic ingredients.
For use in therapy, an effective amount of the immunostimulatory nucleic acid can be
administered to a subject by any mode that delivers the nucleic acid to the desired surface,
e.g., mucosal, systemic. Administering the pharmaceutical composition of the present
invention may be accomplished by any means known to the skilled artisan. Preferred routes
of administration include but are not limited to oral, parenteral, intramuscular, intranasal,
intratracheal, inhalation, ocular, sublingual, vaginal, and rectal.
For oral administration, the compounds (i.e., immunostimulatory nucleic acids,
antigens and other therapeutic agents) can be formulated readily by combining the active
compound(s) with pharmaceutically acceptable carriers well known in the art. Such carriers
enable the compounds of the invention to be formulated as tablets, pills, dragees, capsules,
liquids, gels, syrups, slurries, suspensions and the like, for oral ingestion by a subject to be
treated. Pharmaceutical preparations for oral use can be obtained as solid excipient,

optionally grinding a resulting mixture, and processing the mixture of granules, after adding
suitable auxiliaries, if desired, to obtain tablets or dragee cores. Suitable excipients are, in
particular, fillers such as sugars, including lactose, sucrose, mannitol, or sorbitol; cellulose
preparations such as, for example, maize starch, wheat starch, rice starch, potato starch,
gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, sodium
carboxymethylcellulose, and/or polyvinylpyrrolidone (PVP). If desired, disintegrating agents
may be added, such as the cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt
thereof such as sodium alginate. Optionally the oral formulations may also be formulated in
saline or buffers for neutralizing internal acid conditions or may be administered without any
carriers.
Dragee cores are provided with suitable coatings. For this purpose, concentrated
sugar solutions may be used, which may optionally contain gum arabic, talc, polyvinyl
pyrrolidone, carbopol gel, polyethylene glycol, and/or titanium dioxide, lacquer solutions,
and suitable organic solvents or solvent mixtures. Dyestuffs or pigments may be added to the
tablets or dragee coatings for identification or to characterize different combinations of active
compound doses.
Pharmaceutical preparations which can be used orally include push-fit capsules made
of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol
or sorbitol. The push-fit capsules can contain the active ingredients in admixture with filler
such as lactose, binders such as starches, and/or lubricants such as talc or magnesium stearate
and, optionally, stabilizers. In soft capsules, the active compounds may be dissolved or
suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene
glycols. In addition, stabilizers may be added. Microspheres formulated for oral
administration may also be used. Such microspheres have been well defined in the art. All
formulations for oral administration should be in dosages suitable for such administration.
For buccal administration, the compositions may take the form of tablets or lozenges
formulated in conventional manner.
For administration by inhalation, the compounds for use according to the present
invention may be conveniently delivered in the form of an aerosol spray presentation from
pressurized packs or a nebulizer, with the use of a suitable propellant, e.g.,
dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide
or other suitable gas. In the case of a pressurized aerosol the dosage unit may be determined

by providing a valve to deliver a metered amount. Capsules and cartridges of e.g., gelatin for
use in an inhaler or insufflator may be formulated containing a powder mix of the compound
and a suitable powder base such as lactose or starch.
The compounds, when it is desirable to deliver them systemically, may be formulated
for parenteral administration by injection., e.g., by bolus injection or continuous infusion.
Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in
multi-dose containers, with an added preservative. The compositions may take such forms as
suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory
agents such as suspending, stabilizing and/or dispersing agents.
Pharmaceutical formulations for parenteral administration include aqueous solutions
of the active compounds in water-soluble form. Additionally, suspensions of the active
compounds may be prepared as appropriate oily injection suspensions. Suitable lipophilic
solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acid esters, such as
ethyl oleate or triglycerides, or liposomes. Aqueous injection suspensions may contain
substances which increase the viscosity of the suspension, such as sodium carboxymethyl
cellulose, sorbitol, or dextran. Optionally, the suspension may also contain suitable
stabilizers or agents which increase the solubility of the compounds to allow for the
preparation of highly concentrated solutions.
Alternatively, the active compounds may be in powder form for constitution with a
suitable vehicle, e.g., sterile pyrogen-free water, before use.
The compounds may also be formulated in rectal or vaginal compositions such as
suppositories or retention enemas, e.g., containing conventional suppository bases such as
cocoa butter or other glycerides.
In addition to the formulations described previously, the compounds may also be
formulated as a depot preparation. Such long acting formulations may be formulated with
suitable polymeric or hydrophobic materials (for example as an emulsion in an acceptable
oil) or ion exchange resins, or as sparingly soluble derivatives, for example, as a sparingly
soluble salt.
The pharmaceutical compositions also may comprise suitable solid or gel phase
carriers or excipients. Examples of such carriers or excipients include but are not limited to
calcium carbonate, calcium phosphate, various sugars, starches, cellulose derivatives, gelatin,
and polymers such as polyethylene glycols.

Suitable liquid or solid pharmaceutical preparation forms are, for example, aqueous or
saline solutions for inhalation, microencapsulated, encochleated, coated onto microscopic
gold particles, contained in liposomes, nebulized, aerosols, pellets for implantation into the
skin, or dried onto a sharp object to be scratched into the skin. The pharmaceutical
compositions also include granules, powders, tablets, coated tablets, (micro)capsules,
suppositories, syrups, emulsions, suspensions, creams, drops or preparations with protracted
release of active compounds, in whose preparation excipients and additives and/or auxiliaries
such as disintegrants, binders, coating agents, swelling agents, lubricants, flavorings,
sweeteners or solubilizers are customarily used as described above. The pharmaceutical
compositions are suitable for use in a variety of drug delivery systems. For a brief review of
methods for drug delivery, see Langer(1990) Science 249:1527-33, which is incorporated
herein by reference.
The immunostimulatory nucleic acids and optionally other therapeutics and/or
antigens may be administered per se (neat) or in the form of a pharmaceutically acceptable
salt. When used in medicine the salts should be pharmaceutically acceptable, but non-
pharmaceutically acceptable salts may conveniently be used to prepare pharmaceutically
acceptable salts thereof. Such salts include, but are not limited to, those prepared from the
following acids: hydrochloric, hydrobromic, sulfuric, nitric, phosphoric, maleic, acetic,
salicylic, p-toluene sulphonic, tartaric, citric, methane sulphonic, formic, malonic, succinic,
naphthalene-2-sulphonic, and benzene sulphonic. Also, such salts can be prepared as alkaline
metal or alkaline earth salts, such as sodium, potassium or calcium salts of the carboxylic
acid group.
Suitable buffering agents include: acetic acid and a salt (1-2% w/v); citric acid and a
salt (1-3% w/v); boric acid and a salt (0.5-2.5% w/v); and phosphoric acid and a salt (0.8-2%
w/v). Suitable preservatives include benzalkonium chloride (0.003-0.03% w/v);
chlorobutanol (0.3-0.9% w/v); parabens (0.01-0.25% w/v) and thimerosal (0.004-0.02% w/v).
The pharmaceutical compositions of the invention contain an effective amount of an
immunostimulatory nucleic acid and optionally antigens and/or other therapeutic agents
optionally included in a pharmaceutically acceptable carrier. The term "pharmaceutically
acceptable carrier" means one or more compatible solid or liquid filler, diluents or
encapsulating substances which are suitable for administration to a human or other vertebrate
animal. The term "carrier" denotes an organic or inorganic ingredient, natural or synthetic,

with which the active ingredient is combined to facilitate the application. The components of
the pharmaceutical compositions also are capable of being commingled with the compounds
of the present invention, and with each other, in a manner such that there is no interaction
For treatment of a subject, depending on activity of the compound, manner of
administration, purpose of the immunization (i.e., prophylactic or therapeutic), nature and
severity of the disorder, age and body weight of the patient, different doses may be necessary.
The administration of a given dose can be carried out both by single administration in the
form of an individual dose unit or else several smaller dose units. Multiple administration of
doses at specific intervals of weeks or months apart is usual for boosting the antigen-specific
responses.
Other delivery systems can include time-release, delayed release or sustained release
delivery systems. Such systems can avoid repeated administrations of the compounds,
increasing convenience to the subject and the physician. Many types of release delivery
systems are available and known to those of ordinary skill in the art. They include polymer
base systems such as poly(lactide-glycolide), copolyoxalates, polycaprolactones,
polyesteramides, polyorthoesters, polyhydroxybutyric acid, and polyanhydrides.
Microcapsules of the foregoing polymers containing drugs are described in, for example, U.S.
Patent 5,075,109. Delivery systems also include non-polymer systems that are: lipids
including sterols such as cholesterol, cholesterol esters and fatty acids or neutral fats such as
mono-, di-, and tri-glycerides; hydrogel release systems; silastic systems; peptide based
systems; wax coatings; compressed tablets using conventional binders and excipients;
partially fused implants; and the like. Specific examples include, but are not limited to: (a)
erosional systems in which an agent of the invention is contained in a form within a matrix
such as those described in U.S. Patent Nos. 4,452,775, 4,675,189, and 5,736,152, and (b)
diffusional systems in which an active component permeates at a controlled rate from a
polymer such as described in U.S. Patent Nos. 3,854,480, 5,133,974 and 5,407,686. In
addition, pump-based hardware delivery systems can be used, some of which are adapted for
implantation.
The present invention is further illustrated by the following Examples, which in no
way should be construed as further limiting. The entire contents of all of the references
(including literature references, issued patents, published patent applications, and co-pending

patent applications) cited throughout this application are hereby expressly incorporated by
reference.
Examples
Example 1. ODN 2395 is a remarkably strong activator of NK cells and IFN-a production.
We previously recognized and described oligodeoxynucleotides (ODN) containing
neutralizing motifs consisting of repeats of the sequence CG such as CGCGCG or where the
CG is preceded by a C and/or followed by a G. These neutralizing motifs were believed to
reduce the stimulatory effects of ODN on multiple readouts, such as secretion of IL-6, IL-12,
IFN-?, TNF-a, and induction of an antigen-specific immune response. Krieg AM et al.
(1998) Proc Natl Acad Sci USA 95:12631 -6.
In many cases, the presence of a neutralizing motif in an oligonucleotide together with
a stimulatory motif was believed to prevent immune activation. One such ODN containing
both stimulatory and neutralizing motifs is ODN 2136, which has the sequence
TCCTGACGTTCGGCGCGCGCCC (SEQ ID NO: 19). The 3' end of this ODN contains a
fairly typical neutralizing motif, CGGCGCGCGCCC (SEQ ID NO: 37), derived from the 3'
end of the inhibitory ODN 2010 (GCGGCGGGCGGCGCGCGCCC, SEQ ID NO: 38).
Surprisingly, ODN 2136 had strong activity for inducing NK cell lytic activity (lytic units,
L.U.). As shown in Table 1, ODN 2136 at a concentration of 3 µg/ml was actually stronger
than our standard B-cell and NK cell stimulatory phosphorothioate ODN 2006
(TCGTCGTTTTGTCGTTTTGTCGTT, SEQ ID NO: 39) for induction of L.U. More
strikingly, whereas ODN 2006 only induced the production of 2,396 pg/ml of IFN-a, ODN
2136 induced the production of 14,278 pg/ml (Figure 1). This indicated that, surprisingly,
the presence of this neutralizing sequence was not necessarily to be avoided.



However, in an effort to understand this observation, an even stronger NK activator
and IFN-a inducer was created by combining the 3' end of ODN 2136 with the 5' end of
ODN 2006. The resulting ODN 2395 (TCGTCGTTTTCGGCGCGCGCCG, SEQ ID NO: 1)
serendipitously incorporated a change of the last base on the 3' end from a C to a G. This
single base change has the effect of creating a perfect 12-base-long palindrome at the 3' end
of ODN 2395 where in ODN 2136 the palindrome is only 10 bases long.
Table 2 shows another example of data where ODN 2395 is remarkably potent at
inducing NK cell L.U. compared to most other all-phosphorothioate backbone ODN. In this

assay ODN 2395 is weaker than the positive control ODN 1585, which has a chimeric
phosphorothioate/phosphodiester (SOS) backbone. ODN 1585
(ggGGTCAACGTTGAgggggG, SEQ ID NO: 35), is described in published PCT Application
WO 01/22990. At the low concentration of 0.6 ug/ml tested in this experiment, ODN 2136
induced no L.U. above the background of 0.03 in the no-ODN control. Figure 2 and Figure
3 show the level of monocyle chemotactic protein (MCP)-1 and IFN-inducible protein (IP)-
10, respectively, in the supernatants from the NK cell cultures in Table 2. MCP-1 is a
chemokine that is a ligand for CCR2 and is associated with both Th1 and Th2-type immune
responses. IP-10 is a CXC chemokine that is a ligand for CXCR3 and is associated with Th1
responses. Loetscher P et al. (2001) J Biol Chem 276:2986-91. These data show that ODN
2395 is a relatively strong inducer of IP-10 production, but induces only average levels of
MCP-1.



Based on these and other data, we concluded that the ODN 2395 sequence was a
remarkably strong activator of NK cells and IFN-a production.
Example 2. ODN related to ODN 2395 are also strong activators of NK cells and IFN-a
production.
Additional ODN 2427-2433 (SEQ ID NOs: 2 - 8) were designed and synthesized to
test the possibility that the palindrome.at the 3' end of ODN 2395 may be important in its
immune stimulatory activity. Table 3 compares the ability of these different ODN to activate
NK L.U. As is evident from these data, the strongest ODN at the concentration of 1 µg/ml is
ODN 2429 (TCGTCGTTTTCGGCGGCCGCCG, SEQ ID NO: 4) which induced 2.85 L.U.
of NK activity. ODN 2006 was very weak in the experiment, and all of the other oligos that
were tested except for the control ODN 2118 (GGGGTCAAGCTTGAGGGGGG, SEQ ID
NO: 36) that has no CG were stronger than 2006. ODN 2429 is notable because it is the only

one that maintains a 12-base palindrome, although this is a different palindrome from the one
that was present in 2395. ODN 2430 (TCGTCGTTTTCGGCGCGCCGCG, SEQ ID NO: 5),
which is the second strongest ODN at the 1 µg/ml concentration, is similar; but the
palindrome has been slightly shortened to 10 bases long. The remainder of the ODN have
either no or shorter palindromic sequences, and induce less NK activity.


2432 TCGTCGTTTTCGGCCCGCGCGG (SEQ ID NO: 7)
2433 TCGTCGTTTTCCGCCGCCGGGG (SEQ ID NO: 8)
Figure 4 shows the ability of these oligos to induce IFN-a production compared to
the positive control SOS ODN 2216 (GGGGGACGATCGTCGGGGG, SEQ ID NO: 55),
2334 (GGGGTCGACGTCGACGTCGAGGGGGGG, SEQ ID NO: 56), and 2336
(GGGGACGACGTCGTGGGGGGG, SEQ ID NO: 57). All of the 2395-related ODN induce
a higher level of IFN-a production than ODN 2006, although the levels are below the levels
induced by the chimeric SOS ODN. The rank order of induction of IFN-a expression is
roughly similar to that of NK L.U., with the strongest effects seen by ODN 2395 and 2429.
Example 3. The strong stimulatory effects on NK cells and IFN-a production do not
correspond to B-cell effects.
As shown in Figure 5A, ODN 2395 and its relatives were significantly weaker at a
0.25 µg/ml concentration than ODN 2006 or its relative 2397, in terms of their ability to
induce B-cell expression of CD86 at 48 hours. As we have noticed previously, at higher
ODN concentrations such as 1 µg/ml, less difference was seen between the various ODN
(Figure 5B). In the same experiment, we also measured B-cell activation by a proliferation
assay (3H-thymidine incorporation; Figure 6). Again, at the 0.25 µg/ml concentration ODN
2006 and ODN 2397 (SEQ ID NO: 44) were by far the strongest (Figure 6A). However, at
higher concentrations, the 2395-related ODN were similar in their efficacy (Figure 6B).
Example 4. ODN 2395 and related ODN are weak inducers of IL-10.
Our previous studies have suggested that most of the IL-10 production that is induced
by CpG is derived from B cells. As shown in Figure 7, IL-10 expression correlated well
with B-cell proliferation. Again, ODN 2006 and its relative ODN 2397 were the strongest at
the low concentration of 0.25 µg/ml. ODN 2395 and its relatives induced less IL-10
production at this concentration.
Example 5. Concentration dependence of immune stimulatory effect.
Additional studies on this class of oligonucleotides and the derivatives involved ODN
numbers 2427-2433 (SEQ ID NOs: 2 - 8). Data for these ODN are shown in Figure 8. This
demonstrates again that ODN 2006 was very weak at inducing IFN-a production at a
concentration of either 1 or 6 µg/ml. However, ODN 2395 induced substantial amounts of
IFN-a, especially at the lower concentration of 1 µg/ml. We have occasionally seen ODN
where the stimulatory activity was reduced at higher concentrations, such as 6 µg/ml, in

comparison to the effects seen at lower concentrations such as 1 µg/ml. In the experiments
shown in Figure 8, ODN 2395 was more potent at the lower concentration than at the higher
concentration, but ODN 2429 was more potent at the higher concentration. In contrast to the
common inverted dose-response curve of phosphorothioate ODN, chimeric ODN such as
ODN 2336 in this experiment typically showed increased immune stimulatory effects at
higher concentrations. The stimulatory effect of ODN 2432 in this experiment shown in
Figure 8 was interesting considering that this ODN has no good palindrome. This system
with the relatively weak B cell stimulatory activity is shown in Figure 5 and Figure 6.
Example 6. Reciprocal relationship between B-cell stimulation and NK stimulation and
IFN-a secretion.
Figure 9 shows another experiment, where ODN 2395 at a low concentration of
0.4 µg/ml was significantly weaker than ODN 2006 at inducing B cell expression of CD86.
The other relatives of 2395 show a less marked loss of B cell stimulation. Interestingly, there
is the suggestion of the same rank order for loss of B cell stimulation that had previously
been seen for gain of NK stimulation: ODN 2429, followed by ODN 2430, are the weakest B
cell stimulators among the 2395 relatives. This raises the possibility that the loss of B cell
stimulation by the 2395-like ODN is closely related to the gain of NK stimulation and IFN-a
secretion. Figure 10 and Figure 11 show the IFN-a induction is seen with ODN 2395 and
ODN 2429, followed by ODN 2430. Table 4 and Figure 12, from a separate experiment,
also show the strong ability of ODN 2395 and ODN 2429 to induce IFN-a secretion in two
different human donors (D141 and D142).


2006 TCGTCGTTTTGTCGTTTTGTCGTT (SEQ ID NO: 39)
2336 GGGGACGACGTCGTGGGGGGG (SEQ ID NO: 57)
2395 TCGTCGTTTTCGGCGCGCGCCG (SEQ ID NO: 1)
2429 TCGTCGTTTTCGGCGGCCGCCG (SEQ ID NO: 4)
5293 TCGTCGTTTTCGGCGGCCGCC (SEQ ID NO: 58)
5294 TCGTCGTTTTCGGCCGCCGCC (SEQ ID NO: 59)
5295 TCGTCGTTTTCGGCCGCCGCCG (SEQ ID NO: 60)
5296 TCGTCGTTTTCGCCGCCGCCG (SEQ ID NO: 61)
5297 TGCTGCTTTTCGGCGGCCGCCG (SEQ ID NO: 62)
Example 7. Characteristics of the GC-rich domain.
Surprisingly, none of the ODN 5293-5297 demonstrated strong immune stimulatory
responses. ODN 5293 contains a 10-base palindrome, but the palindrome differs from that in
2395 in that the central CG is inverted to a GC. However, it is believed that this change by
itself cannot explain the loss of activity since ODN 2429 also has such an inversion. Rather,
greater levels of activity may occur with a 12-base palindrome unless there is a central CG in
the palindrome. However, ODN 2430 also has only a 10-base palindrome with a central GC
dinucleotide. The immune stimulatory activity of ODN 2430 may be enhanced by the fact
that it contains five CpG dinucleotides in the 3' terminus, whereas ODN 5293 contains only
three.
ODN 5294 contains only a 6-base palindrome, which could possibly be related to its
low activity. ODN 5295 likewise has no good palindrome. The low activity of ODN 5296
suggests that simple repeats of CCG are not sufficient to confer the immune stimulatory
effects of ODN 2395. ODN 2397 has a perfect 12-base palindrome at the 3' end, but has no
CpG motifs at the 5' end. Since the 12-base palindrome in ODN 5297 is the same at that in
ODN 2429, it can be concluded that the 5' TCGTCG motif of ODN 2429 is important for its
immune stimulatory activity. That is, it is believed that the presence of the neutralizing
palindrome of ODN 2429 at one end of an oligonucleotide will be insufficient to provide
immune stimulatory activity in the absence of at least one stimulatory motif at the other end.
Example 8. Effects on IFN-? production.
Several additional types of assays have been performed to better understand the range
of immune stimulatory effects of this new class of immune stimulatory nucleic acid. Figure
13 shows some of the effects of these ODN on IFN-? production from the supernatants of
human PBMCs. These cells were the same as those used in the experiments shown in Table
3, but the supernatants from the cultures were assayed for their IFN-? levels. Panel C in
Figure 13 shows that SOS CpG ODNs such as ODN 1585 induce some IFN-? production,

whereas ODNs without the CpG motif (e.g., control ODN 2118) do not. Panels A and B of
Figure 13 show that ODN 2006 is relatively weak at inducing IFN-? production, while ODN
2395 and its cousins are somewhat stronger.
Another set of studies was performed to examine the effects of these different ODN
on dendritic cells. The plasmacytoid DC (pDC) is the source of the IFN-a that is produced in
response to ODN 2395 and its relatives. The effects of the various ODN on myeloid DC
(mDC) are relatively similar in that all of the ODN induce partially purified mDC to activate
CD4+ T cells to produce IFN-? (Figure 14 and Figure 15). Myeloid DC were isolated from a
buffy coat and incubated with GM-CSF (4.4 ng/ml) and various ODN for 2 days. CD4+
naïve T cells were then isolated from a different donor and mixed with the DC at selected
effector to target (E:T) ratios and incubated for 6 more days. Cells were then stained and
analyzed by fluorescence activated cell sorting (FACS). Results were measured in terms of
the percentage of CD3+ cells that stained for IFN-?. Figure 14 shows the percentage of T
cells that stained positive for IFN-? and Figure 15 shows the mean fluorescence intensity
(MFI) of IFN-? staining in these T cells.
Example 9. Not all GC-rich palindromes are effective.
Several additional ODN were synthesized in order better to understand the structural
requirements for this new class of ODN. Since we noted that potent immune stimulatory
ODN contained GC-rich palindromes, ODN 2449 (TCGTCGTTTTCGGGGGGCCCCC,
SEQ ID NO: 9) and 2450 (TCGTCGTTTTCCCCCCGGGGGG, SEQ ID NO: 10) were
synthesized to have GC-rich palindromes which were simply straight Gs followed by straight
Cs, or straight Cs followed by straight Gs. As shown in Figure 16, neither of these ODN
induced IFN-a production.
Example 10. Effect of orientation of immune stimulatory sequence and neutralizing motif.
ODN 2451 (TCGGCGCGCGCCGTCGTCGTTT, SEQ ID NO: 11) was synthesized
to test the possibility that the 5' and 3' orientation of the "stimulatory" TCGTCG motif and
the "neutralizing" CGGCGCGCGCCG (SEQ ID NO: 23) palindrome could be inverted
without losing immune stimulatory activity. Indeed, ODN 2451 was highly stimulatory
(Figure 16). ODN 2452 (TCGTCGTTTTCGGCGCGCGCCGTTTTT, SEQ ID NO: 12) was
synthesized to determine whether additional sequence could be added to the 3' end of the
CGGCGCGCGCCG (SEQ ID NO: 23) palindrome without reducing the immune stimulatory

activity, provided the stimulatory TCGTCG motif was on the 5' end. Indeed, this ODN was
also highly immune stimulatory (Figure 16).
Example 11. Variants of ODN 2395 and their induction of IFN-a.
To study in more detail the structural requirements of this new class of ODN to
induce IFN-a secretion, variants of ODN 2395 were synthesized and tested for their
immunostimulatory activity. Table 5 summarizes the data concerning IFN-a induction.

1Underlined are nucleotides that differ from 2395; palindromic sequences are in italics.
2All except ODN 2336, that represents a chimeric backbone ODN (capitals indicate
phosphodiester linkage and lower case represent phosphorothioate linkage), are completely
phosphorothioate ODNs.
From the first set of experiments using the phosphorothioate ODNs 2395 and
2427-2433 it became clear that the palindromic sequence at the 3' end of the ODN has an

important role for induction of IFN-a secretion by dendritic cells that are the main producers
of IFN-a (see 2395 and 2429), although some ODN without such a palindrome at the 3' end
(e.g., ODN 2430 and ODN 2432) also induced IFN-a in somewhat lower amounts (example
in Figure 17A). ODN 2395 and ODN 2429 induced the highest amounts of IFN-a, whereas
2006 (class B ODN) induced none to minimal amounts, and ODN 2336 (class A ODN)
induced large amounts of this cytokine. Most experiments demonstrated that ODN 2429
induced even higher amounts of this cytokine (Figure 17B). An introduction of an additional
TCG motif (e.g., ODN 2427 and ODN 2428) appeared to have negative effects on IFN-a
secretion. Based on data from these and other studies of ODN 2186, the gcc at the 3' end
seemed to play a possible role in the observed effects.
Therefore, we tested another set of ODNs all having GCC sequences at the 3' end.
None of these ODN were observed to induce IFN-a. Therefore, only GCC itself in a
palindrome seems not to be sufficient for the observed effects.
In addition, ODN 5297 with a TGC at the 5' end did not induce any IFN-a despite
bearing the palindromic 3' sequence. This led to the conclusion that not only the 3'
palindromic sequence but also the 5' TCG motif is important for the activity of these ODNs.
This was confirmed by using ODN 5328 (2395 with 5' TGC motif). In contrast to
methylation of class A ODNs, methylation at least of the 5' motif decreased, but did not
abrogate, IFN-a secretion. This finding is in accordance with results obtained with class B
ODNs. Nevertheless, an ODN with part of the 3' palindrome but a different sequence at the
5' end with only one CpG dinucleotide (ODN 2136) also induced IFN-a. In preliminary
results using this ODN and an ODN with the full 3' palindrome (ODN 5315), ODN 5315 was
better than ODN 2136 but not as good as ODN 2395.
The fact that ODN 5329 seems to induce no or only very low amounts of IFN-a
although having a full CG palindrome at the 3' end indicates that specific palindromic
sequences are preferred for IFN-a activity.
Example 12. Reciprocal relationship between B-cell activation and induction of IFN-a
An additional B-cell activation experiment was performed with a panel of some of the
ODNs of Example 11 (Figure 18). The results indicated that the better is an ODN for
induction of IFN-a, the less active it is on B cells (compare especially ODNs 2006, 2336,
2395 and 2429). Nevertheless, it also demonstrated that all of these ODNs were superior to
2336 (class A ODN) in stimulating B cells.

Example 13. Effect on secretion of IFN-y.
We also determined secretion of IFN-? upon incubation of PBMCs with different
concentrations of ODN at different time points (Figure 19 A - C). The ODNs tested induced
IFN-y secretion with the rank order 2336 > 2395, 2429 > 2006. Nevertheless, the difference
between the ODNs was not as clear as by using IFN-a as a read-out.
Example 14. Effect on IFN-? in MLR.
We also determined the effect of these ODN on the induction of IFN-? in a mixed
lymphocyte reaction (MLR). In this setting lymphocytes of one donor respond to antigens
expressed on cells of another donor. The results demonstrated that ODNs 2006, 2336, as well
as 2395 were able to enhance IFN-? secretion during such an antigen-specific response
(Figure 20). This indicated that all these ODN were able to enhance the reactivity to specific
antigen(s).
Example 15. ODN 2395 induces less IL-10 than ODN 2006.
A further set of experiments focused on the induction of the pro-inflammatory
cytokine IL-10. Again, as before for IFN-?, PBMCs were incubated for different times and
with different concentrations of ODNs (Figure 21 A - C). The results demonstrate that, as
shown before, ODN 2006 induces relatively high amounts of IL-10 in contrast to ODN 2336
that induces only minimal to low amounts. In contrast, ODNs 2395 as well as ODN 2429
induce more IL-10 than ODN 2336 but less than ODN 2006. This again confirms that ODN
of this new class of immune stimulatory ODN have stimulatory activities that place them
between those described for ODNs of class A and class B.
Example 16. ODN 2395 induces less TNF-a than ODN 2006 but more than ODN 8954.
Human PBMCs were cultured for 6 hours with 1.6 µg/ml of ODN 2006, 8954, 2395,
2429, or LPS, and supernatants were then harvested and TNF-a measured by specific ELISA.
Results are shown in Table 6.


Additional experiments indicated that cytokines IL-5 as well as IL-15 could not be detected
in our experimental settings upon incubation of PBMCs with these ODNs.
Example 17. Induction of IP-10
Human PBMCs were cultured either alone, in the presence of IL-2, in the presence of
control ODN 1585 or control ODN 2118 at 10 µg/ml, or in the presence of various ODN at
0.6 or 3.0 ug/ml. Supematants were harvested after 24 hours and IP-10 was measured by
specific enzyme-linked immunosorbant assay (ELISA). Results are shown in Figure 22.
ODNs 2395, 2429, 2430, 2432, and 2451 at 3.0 µg/ml, and ODN 2452 at 0.6 µg/ml, all
induced large amounts of IP-10.
Example 18. Induction of IFN-a
Human PBMCs were cultured either alone, in the presence of IL-2, in the presence of
control ODN 1585 or control ODN 2118 at 10 µg/ml, or in the presence of various ODN at
0.6 or 3.0 µg/ml. Supematants were harvested after 24 hours and IFN-a was measured by
specific ELISA. Results are shown in Figure 23A (ODN at 0.6 µg/ml) and Figure 23B
(ODN at 3.0 µg/ml). ODNs 2395,2427,2429, 2430, 2431,2432, and 2451 at 3.0 µg/ml, and
ODN 2452 at 0.6 ng/ml, all induced large amounts of IFN-a.
Example 19. Induction of IFN-?.
Human PBMCs were cultured either alone, in the presence of IL-2, in the presence of
control ODN 1585 or control ODN 2118 at 10 |ag/ml, or in the presence of various ODN at
0.6 or 3.0 |xg/ml. Supematants were harvested after 24 hours and IFN-y was measured by
specific ELISA. Results are shown in Figure 24. ODNs 2395, 2427, 2429,2430, 2431,
2432,2451 and 2452 at 3.0 ug/ml, and ODN 2352 at 0.6 ug/ml, all induced large amounts of
IFN-Y.
Example 20. Induction of IL-6.
Human PBMCs were cultured either alone, in the presence of IL-2, in the presence of
control ODN 1585 or control ODN 2118 at 10 ug/ml, or in the presence of various ODN at
0.6 or 3.0 fig/ml. Supematants were harvested after 24 hours and IL-6 was measured by
specific ELISA. Results are shown in Figure 25. ODNs 2395, 2430, 2432, 2433, 2136,
2449,2450,2451 and 2452 at 0.6 ug/ml, and ODN 2449 and ODN 2451 at 3.0 ug/ml, all
induced large amounts of IL-6.
Example 21. Induction of IFN-a.

Human PBMCs were cultured either alone or in the presence of various ODN at 3.0 or
6.0 fig/ml. ODNs included 2006, 8954, 2395, 2449, 2450, 2451, 2452, 5373
(CGGCGCGCGCCG, SEQ ID NO: 23), 5374 (CGGCGCGCGCCGCGGCGCGCGCCG,
SEQ ID NO: 24), 5375 (CGGCGCGCGCCGTCGTCGTTT, SEQ ID NO: 25), 5376
(TCGGCGCGCGCCGTGCTGCTTT, SEQ ID NO: 26), and 5377
(CCGCCGTTTTCGGCGCGCGCCG, SEQ ID NO: 27). Supernatants were harvested after
24 hours and IFN-oc was measured by specific ELISA. Results are shown in Figure 26.
ODNs 2395, 2451, 2452, and 5376 all induced IFN-ct.
Example 22. Induction of IFN-a by ODN 5515 and ODN 5516.
Human PBMCs obtained from two donors (D346 and D240) were cultured either
alone or in the presence of ODN 2006, ODN 5515, or ODN 5516 at 0.8, 2.4, or 6.0 ug/ml.
Supernatants were harvested after 24 hours and IFN-a was measured by specific ELISA.
Results are shown in Table 7. ODN 5515 and ODN 5516 induced IFN-a more effectively
than ODN 2006, particularly at ODN concentrations of 2.4 and 6.0 ug/ml.
Example 23. Induction of IFN-a by ODN 20184, 20185, and 20186.
Human PBMCs obtained from three donors (D445, D446, and D448) were cultured
either alone or in the presence of ODN 2006, ODN 20184, ODN 20185, or ODN 20186 at
0.05, 0.1, 0.2,0.5, or 1.0 jig/ml. Supernatants were harvested after 24 hours and IFN-a was
measured by specific ELISA. Results are shown in Table 8. ODN 20184, ODN 20185, and
ODN 20186 induced IFN-a more effectively than ODN 2006, particularly at 0.2-0.5 ue/ml.



Human PBMCs obtained from three donors (D521, D525, and D526) were cultured
either alone or in the presence of ODN 2006 (SEQ ID NO: 39), ODN 8954, ODN 5569
(TIGTIGTTTTCGGCGGCCGCCG SEQ ID NO: 63), or ODN 5570
(TCITCITTTTCGGCGGCCGCCG SEQ ID NO: 70) at 0.03, 0.06, 0.125,0.25, or 1.0
µg/ml. Supernatants were harvested after 24 hours and IFN-a and IL-10 were measured by
specific ELISA. Results are shown in Table 9 and 10.
Table 9. Induction of IFN-a (pg/ml) by ODN 8954, 5569, and 5570




The foregoing written specification is considered to be sufficient to enable one skilled
in the art to practice the invention. The present invention is not to be limited in scope by
examples provided, since the examples are intended as a single illustration of one aspect of
the invention and other functionally equivalent embodiments are within the scope of the
invention. Various modifications of the invention in addition to those shown and described

herein will become apparent to those skilled in the art from the foregoing description and fall
within the scope of the appended claims. The advantages and objects of the invention are not
necessarily encompassed by each embodiment of the invention.
All references, patents and patent publications that are recited in this application are
incorporated in their entirety herein by reference.
We claim:

1 An immunostimulatory nucleic acid of 14-100 nucleotides in length having a base
sequence comprising the formula:
5' PX1DCGHX2 3' or 5' X1DCGHX2P 3'
wherein X1 and X2 are independently any sequence 0 to 10 bases long, D is a base other
than C, C is cytosine, G is guanine, H is a base other than G, and P is a GC-rich palindrome-
containing sequence at least 10 bases long, wherein;
a) H is thymine (T) and X2 is CGTTT or CGTTTT,
b) P is completely palindromic, H is T, and X2 is selected from the group consisting of
CG, CGT, CGTT, CGTTT and CGTTTT, and/or
c) P includes at least one hypoxanthine (I),
2. An immunostimulatory nucleic acid as claimed in claim 1, wherein the base sequence
comprises:
a) 5' X1DCGHX2PX3 3', wherein X3 is any sequence 0 to 10 bases long,
b) 5' X1DCGHPX3 3', wherein X3 is any sequence 0 to 10 bases long,
c) 5' DCGHX2PX3 3', wherein X3 is any sequence 0 to 10 bases long,
d) 5' TCGHX2PX3 3'. wherein X3 is any sequence 0 to 10 bases long,
e) 5' DCGHPX3 3', wherein X3 is any sequence 0 to 10 bases long, and/or
f)5'DCGHP3'.
3. An immunostimulatory nucleic acid of 14-100 nucleotides in length having a base
sequence comprising the formula:
5' NX1DCGHX2 3' or 5' X1DCGHX2N 3'
wherein X1 and X2 are independently any sequence 0 to 10 bases long, D is a base other
than C, C is cytosine, G is guanine, H is a base other than G, and N is a B-cell neutralising
sequence beginning with CGG and is at least 10 bases long, wherein:
l)for 5'NX1DCGHX23':
a) H is thymine (T), and/or

b) H is T and X2 is selected from the group consisting of CG, CGT, CGTT,
CGTTT, and CGTTTT, and
2)for 5'XlDCGHX2N3':
a) H is T and X2 is CGTTTT,
4. An immunostimulatory nucleic acid as claimed in claim 1, wherein in the formulae
5' PX1DCGHX2 3' and 5' X1DCGHX2P 3', the C is unmethylated.
5. An immunostimulatory nucleic acid as claimed in claim 3, wherein in the formulae
5' NX1DCGHX2 3' and 5' X1DCGHX2N3', the C is unmethylated.
6. An immunostimulatory nucleic acid as claimed in any one of claims 1-5, wherein the
immunostimulatory nucleic acid:

a) has a nuclease-resistant backbone,
b) has a phosphorothioate backbone,
c) has a chimeric backbone,
d) is 14-40 nucleotides in length, and/or
e) is 14-30 nucleotides in length.

7. An immunostimulatory nucleic acid as claimed in any one of claims 1 -6, wherein the
base sequence further comprises a poly-T sequence at the 5' end and/or at the 3' end.
8. An immunostimulatory nucleic acid of 13-100 nucleotides in length having a base
sequence comprising the formula;
5'N1PyGN2P 3'
wherein N1 is any sequence 1 to 6 bases long, Py is a pyrimidine, G is guanine, N2 is any
sequence 0 to 30 bases long, and P is a GC-rich palindrome-containing sequence at least 10
bases long, wherein N1:
a) includes at least one cytosine-hypoxanthine (CI) motif,
b) includes at least one thymine-CI (TCI) motif,
c) includes at leas: one IG motif,

d) includes at least one TIG motif, and/or
e) is TCGG.
9. An immunostimulatory nucleic acid as claimed in claim 8, wherein:
a) Py is unmethylated C,
b) N2 is at least 50% pyrimidines,
c) N2 is at least 50% T,
d) N2 does not include any poly-G or poly-A motifs, and/or
e) N1PyGN2 is a sequence selected from the group consisting of TTTCG, TTTTCG,
TTTTTCG, TTCGT, and TTTCGT.
10. An immunostimulatory nucleic acid as claimed in claim 8, wherein the
immunostimulatory nucleic acid has:
a) a completely nuclease-resistant backbone, optionally wherein the nuclease-resistant
backbone is composed of phosphorothioate linkages,
b) a completely phosphodiester backbone, and/or
c) a chimeric backbone, preferably wherein the immunostimulatory nucleic acid has at
least one phosphodiester linkage between a CG, CI or IG motif.
11. An immunostimulatory nucleic acid as claimed in claim 8, wherein P:
a) is completely palindromic,
b) is a palindrome-containing sequence having between 1 and 3 consecutive intervening
bases, preferably wherein the intervening bases are TG,
c) includes at least 3 C and at least 3 G bases,
d) includes at least 4 C and at least 4 G bases,
e) includes at least 5 C and at least 5 G bases, and/or
f) includes at least one hypoxanthine,
12. An immunostimulatory nucleic acid as claimed in claim 8, wherein the
immunostimulatory nucleic acid is:
a) 13-40 nucieotides in length, and/or

b) 13-30 nucleotides in length.
13, An immunostimulatory nucleic acid of 13-100 nucleotides in length having a base
sequence comprising the formula:
5'N1PyG/IN2P 3'
wherein N1 is any sequence 1 to 6 bases long, Py is a pyrimidine, G/I refers to a single
base which is either a G or an 1, G is guanine and I is hypoxanthine, N2 is any sequence 0 to 30
bases long, and P is a palindrome-containing sequence at least 10 bases long, wherein when G/I
is G, P is an IC-rich palindrome.
14, An immunostimulatory nucleic acid as claimed in claim 13, wherein when G/I is I:
a) N1PyIN2 is TCITCITTTT (SEQ ID NO: 47),
b) P is a GC-rich palindrome, and/or
c) P is an IC-rich palindrome.

15, An immunostimulatory nucleic acid as claimed in claim 1-3, wherein the
immunostimulatory nucleic acid is 13-30 nucleotides in length,
16, A pharmaceutical composition comprising an irrimunostirnulatory nucleic acid as claimed
in any one of claims 1-15 and a pharmaceutically acceptable carrier.
17, A pharmaceutical composition as claimed in claim 16, further comprising an antigen,
optionally a tumour antigen.
18, An in vitro method for inducing type 1 interferon (IFN) expression, comprising
contacting a cell capable of expressing type 1 IFN with an immunostimulatory nucleic acid as
claimed in any one of claims 1-15.
19, An in vitro method for activating a natural killer (NK) cell, comprising contacting an NK
cell with an immunostimulatory nucleic acid as claimed in any one of claims 1-15,

20. An immunostimulatory nucleic acid as claimed in any one of claims 1-15, for use in a
therapeutic method comprising contacting the immunostimulatory nucleic acid with a cell
capable of expressing type 1 interferon (IFN) and thereby inducing expression of type 1 IFN.
21. An immunostimulatory nucleic acid as claimed in any one of claims 1-15, for use in a
therapeutic method comprising contacting the immunostimulatory nucleic acid with a natural
killer (NK) cell and thereby activating the NK cell.
22. An immunostimulatory nucleic acid as claimed in any one of claims 1-15, for use in a
therapeutic method comprising treating or preventing an infection in a subject having, or at risk
of developing, said infection.
23. An immunostimulatory nucleic acid as claimed in claim 22, wherein the subject has, or is
at risk of developing, an infection selected from the group consisting of a viral, bacterial, fungal
and parasitic infection,
24. An immunostimulatory nucleic acid as claimed in any one of claims 1-15, for use in a
therapeutic method comprising treating or preventing an allergic condition in a subject having, or
at risk of developing, said allergic condition.
25. An immunostimulatory nucleic acid as claimed in claim 24, wherein the allergic
condition is allergic asthma.
26. An immunostimulatory nucleic acid as claimed in any one of claims 1-15, for use in a
therapeutic method comprising treating or preventing cancer in a subject having, or at risk of
developing, cancer.
27. An immunostimulatory nucleic acid as claimed in claim 26, wherein the cancer is
selected from the group consisting of;
basal cell carcinoma, biliary tract cancer, bladder cancer, bone cancer, brain and CNS
cancer, breast cancer, cervical cancer, choriocarcinoma, colon and rectum cancer, connective

tissue cancer, cancer of the digestive system, endometrial cancer, oesophageal cancer, eye
cancer, cancer of the head and neck, gastric cancer, intra-epithelial neoplasm, kidney cancer,
larynx, cancer, leukemia, liver cancer, lung cancer, lymphoma including Hodgkin's and non-
Hodgkin's lymphoma, melanoma, myeloma, neuroblastoma, oral cavity cancer, ovarian cancer,
pancreatic cancer, prostate cancer, retinoblastoma, rhabdomyosarcoma, rectal cancer, renal
cancer, cancer of the respiratory system, sarcoma, skin cancer, stomach cancer, testicular cancer,
thyroid cancer, uterine cancer, cancer of the urinary system, and other carcinomas and sarcomas.
28. An immunostimulatory nucleic acid having a base sequence comprising:
TCGTCGTTTTCGGCGCGCGCCG (SEQ ID NO: 1),
TCGTCGTTTTCGGCGGCCGCCG (SEQ ID NO: 4),
TCGTCGTTTTCGGCGCGCCGCG (SEQ ID NO: 5),
TCGTCGTTTTCGGCGCCGGCCG (SEQ ID NO. 6),
TCGTCGTTTTCGGCCCGCGCGG (SEQ ID NO: 7),
TCGTCGTTTTCGGCGCGCGCCGTTTTT (SEQ ID NO: 12)
TCCTGACGTTCGGCGCGCGCCG (SEQ ID NO: 13),
TZGTZGTTTTZGGZGZGZGZZG (SEQ ID NO: 14), wherein Z is 5-methylcytosine,
TCGGCGCGCGCCGTCGTCGTTT (SEQ ID NO: 11) or
TCITCITTTTCGGCGGCCGCCG (SEQ ID NO: 70), wherein I is inosine.
A class of highly immunostimulatory nucleic acids (ODNs) having two distinct motifs, a
CpG motif and either a GC-rich motif or a B-cell neutralising motif, is provided. The invention
relates in part to ODNs having the formula 5'PX1DCGHX23' or 5'X1DCGHX2P3', wherein X1
and X2 are independently any sequence 0 to 10 bases long, D is any base but C, C is cytosine, G
is guanine, H is any base but G, and P is a GC-rich palindrome-containing sequence. This
invention also relates in part to ODNs having the formula 5' NX1 DCGHX23' or
5'X1DCGHX2N3', wherein N is a B-cell neutralising sequence. Also provided are ODNs having
the formula 5'NPyGN2P3' or 5'N1PyG/IN2P3', wherein N1 is any sequence 1 to 6 bases long, Py
is pyrimidine, N2 is any sequence 0 to 30 bases long and G/I is either G or I. Methods of using
the ODNs of the invention are provided.

Documents:


Patent Number 223023
Indian Patent Application Number 00162/KOLNP/2004
PG Journal Number 36/2008
Publication Date 05-Sep-2008
Grant Date 03-Sep-2008
Date of Filing 06-Feb-2004
Name of Patentee COLLEY PHARMACEUTICAL GMBH
Applicant Address
Inventors:
# Inventor's Name Inventor's Address
1 KRIEG ARTHUR M 173 WINDING RIVER ROAD, WELLESLEY MA 02481
2 VOLLMER JORG KOHLRAUSCHWEG 24, 40591 DUESSELDOR
3 ULHMAN EUGEN COLEY PHARMACEUTICAL GMBH, ELISABETH-SELBERT-STRASSE 9, 40764 LANGENFELD
PCT International Classification Number A 61 K 31/44
PCT International Application Number PCT/US02/26468
PCT International Filing date 2002-08-19
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 60/393,952 2002-07-03 U.S.A.
2 60/313,273 2001-08-17 U.S.A.